Thrombotic microangiopathy associated with combined sirolimus and tacrolimus immunosuppression after intestinal transplantation.
Calcineurin inhibitor-induced thrombotic microangiopathy (TMA) has been described in up to 14% of solid-organ transplant recipients. Sirolimus has recently been described in two reports in association with TMA. Sirolimus is known to potentiate cyclosporine-induced nephrotoxicity, but such effect has not been shown with tacrolimus. We report two intestinal transplant patients who developed TMA while on a tacrolimus and sirolimus immunosuppressive regimen. This syndrome appeared soon after institution of or increase in sirolimus dosage and improved only after this medication was discontinued.
Paramesh
Anil S
AS
The Recanati/Miller Transplantation Institute, Division of Intestinal Transplantation, The Mount Sinai School of Medicine, New York, New York, USA.
Grosskreutz
Celia
C
Florman
Sander S
SS
Gondolesi
Gabriel E
GE
Sharma
Sanjay
S
Kaufman
Stuart S
SS
Fishbein
Thomas M
TM
D000328:Adult; D065095:Calcineurin Inhibitors; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008833:Microcirculation; D020123:Sirolimus / Q000009:adverse effects*; D016559:Tacrolimus / Q000009:adverse effects*; D013927:Thrombosis / Q000139:chemically induced*
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus