Calcineurin inhibitor-free immunosuppression in renal allograft recipients with thrombotic microangiopathy/hemolytic uremic syndrome.
Thrombotic microangiopathy (TMA) and hemolytic uremic syndrome (HUS) represent serious threats to kidney allograft recipients. During a 4-year period, among 850 kidney transplantations, seven recipients with primary HUS and seven recipients (eight transplants) with previous or de novo TMA/HUS were identified and given calcineurin inhibitor (CNI)-free immunosuppression by sirolimus (SRL), mycophenolate mofetil and steroids. Thirteen out of 15 transplantations were successful in the long term; resulting in a mean creatinine of 101 mumol/L (16.4 months follow-up). In patients maintained on CNI-free regimen, no TMA/HUS recurrences were observed. A high rate of acute rejections (53%) may indicate insufficient immunosuppressive power and/or a causative relationship between TMA/HUS and rejection. Wound-related complications were abundant (60%), and call for surgical/immunosuppressive countermeasures. Our experience supports the idea that CNI's are major offenders in TMA/HUS induction. Total CNI elimination seems essential, as the nephrotoxic combination CNI + SRL may promote TMA. Features of TMA/HUS should be carefully explored in recurrent 'high responders'.
Oyen
O
O
Surgical Department, Transplant Section, The Rikhospitalet University Hospital, 0027 Oslo, Norway. ole.oyen@rikhospitalet.no
Strøm
E H
EH
Midtvedt
K
K
Bentdal
O
O
Hartmann
A
A
Bergan
S
S
Pfeffer
P
P
Brekke
I B
IB
D000328:Adult; D002102:Cadaver; D065095:Calcineurin Inhibitors; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000601:surgery*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery; D012079:Renal Circulation; D012189:Retrospective Studies; D014019:Tissue Donors
D065095:Calcineurin Inhibitors