title: Thrombotic microangiopathy after simultaneous pancreas-kidney transplantation.
abstract: Thrombotic microangiopathy (TMA) is rare after transplantation and is associated with a high incidence of kidney graft dysfunction. Between December 2000 and March 2006, 136 simultaneous pancreas-kidney transplantations were performed with an incidence of TMA of 5.1% (71.4% localized to kidney allograft). All cases were diagnosed during the first three months and were attributed to tacrolimus; 74% were women. Systemic TMA presented higher values of lactate dehydrogenase (2658 +/- 659 U/L vs. 1331 +/- 473 U/L, p = 0.04) and a greater decrease in hematocrit (45.8 +/- 17.7% vs. 19.2 +/- 6%, p = 0.02) than in localized TMA. Acute kidney rejection complicated almost 90% of the cases with 43% of kidney graft lost. Tacrolimus was switched to sirolimus and fresh-frozen plasma was administered. Creatinine clearance after a mean follow-up of two yr was 100.7 mL/min/1.73 m(2) and 57.9 mL/min/1.73 m(2) in patients with systemic and localized TMA, respectively. In conclusion, sirolimus is an alternative to TMA associated with tacrolimus.
authors.affiliation: Nephrology Division, Universidade Federal de São Paulo, Brazil. erikabr@uol.com.br
authors.forename: Erika B
authors.initials: EB
authors.lastname: Rangel
authors.forename: Adriano M
authors.initials: AM
authors.lastname: Gonzalez
authors.forename: Marcelo M
authors.initials: MM
authors.lastname: Linhares
authors.forename: Sérgio R R
authors.initials: SR
authors.lastname: Araújo
authors.forename: Marcello F
authors.initials: MF
authors.lastname: Franco
authors.forename: João R
authors.initials: JR
authors.lastname: de Sá
authors.forename: José O M
authors.initials: JO
authors.lastname: Pestana
authors.forename: Cláudio S
authors.initials: CS
authors.lastname: Melaragno
mesh_terms: D000293:Adolescent; D000328:Adult; D002196:Capillaries / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007668:Kidney / Q000098:blood supply*; D007678:Kidney Glomerulus / Q000098:blood supply / Q000473:pathology; D016030:Kidney Transplantation; D008875:Middle Aged; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D013927:Thrombosis / Q000139:chemically induced*
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus