title: Retinal injury as an early manifestation of posttransplant thrombotic microangiopathy: recovery with plasma exchanges and conversion to sirolimus--case report and review of the literature.
abstract: Thrombotic microangiopathy (TMA) remains a serious event. We report a case of occurrence of TMA in the immediate postoperative period after a living-related renal transplantation. A distinguished feature of the case was major, early involvement of the retina with marked by decreased visual acuity along with thrombocytopenia and renal functional impairment. The syndrome was reversible with plasma exchange and conversion from tacrolimus to sirolimus. The patient's renal function is excellent at 11 months after transplantation. Decreased visual acuity and cotton wool exudates may be the first manifestation of posttransplant TMA.
authors.affiliation: Department of Nephrology-Royal Hospital, Muscat, Oman. nabmoh@omantel.net.om
authors.forename: N
authors.initials: N
authors.lastname: Mohsin
authors.forename: C
authors.initials: C
authors.lastname: Nooyi
authors.forename: A
authors.initials: A
authors.lastname: Jha
authors.forename: M
authors.initials: M
authors.lastname: Budruddin
authors.forename: P
authors.initials: P
authors.lastname: Kamble
authors.forename: M
authors.initials: M
authors.lastname: Khalil
authors.forename: A
authors.initials: A
authors.lastname: Pakkyarra
authors.forename: E
authors.initials: E
authors.lastname: Mohammed
authors.forename: H
authors.initials: H
authors.lastname: Ahmed
authors.forename: A
authors.initials: A
authors.lastname: Daar
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D010951:Plasma Exchange; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D012160:Retina / Q000293:injuries* / Q000473:pathology; D020123:Sirolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus