Thrombotic microangiopathy developing in early stage after renal transplantation with a high trough level of tacrolimus.
Thrombotic microangiopathy (TMA) is characterized clinically by hemolytic anemia, thrombocytopenia, and renal failure. Cyclosporine (CyA)-associated TMA is a well-documented complication, but tacrolimus (TAC)-associated TMA is rare. We report the case of a renal transplant recipient who developed TMA in the early stage after renal transplantation with a high trough level of TAC. A 56-year-old female suffering from end-stage renal disease received a living renal graft from a blood-type-identical donor. She had developed hemolytic anemia, thrombocytopenia and acute renal failure 4 days after transplantation (6 days after TAC administration). She was diagnosed as having TMA without rejection by the clinical course and pathological findings. Renal function and hemolytic parameters improved by solely a decrease of the TAC trough level. When TAC-associated TMA develops in renal transplant recipients, we recommend a decrease of the TAC trough level before changing to CyA.
Saito
Mitsuru
M
Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
Satoh
Shigeru
S
Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. shigerus@doc.med.akita-u.ac.jp.
Kagaya
Hideaki
H
Pharmaceutical Science, Akita University School of Medicine, Akita, Japan.
Tsuruta
Hiroshi
H
Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
Obara
Takashi
T
Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
Kumazawa
Teruaki
T
Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
Inoue
Takamitsu
T
Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
Inoue
Kazuyuki
K
Pharmaceutical Science, Akita University School of Medicine, Akita, Japan.
Miura
Masatomo
M
Pharmaceutical Science, Akita University School of Medicine, Akita, Japan.
Yuasa
Takeshi
T
Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
Komatsuda
Atsushi
A
Nephrology and Rheumatology, Akita University School of Medicine, Akita, Japan.
Tsuchiya
Norihiko
N
Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
Habuchi
Tomonori
T
Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation; D008875:Middle Aged; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D014652:Vascular Diseases / Q000139:chemically induced* / Q000175:diagnosis
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus