title: Thrombotic microangiopathy developing in early stage after renal transplantation with a high trough level of tacrolimus.
abstract: 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.
authors.affiliation: Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Saito
authors.affiliation: Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. shigerus@doc.med.akita-u.ac.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Satoh
authors.affiliation: Pharmaceutical Science, Akita University School of Medicine, Akita, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kagaya
authors.affiliation: Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tsuruta
authors.affiliation: Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Obara
authors.affiliation: Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Teruaki
authors.initials: T
authors.lastname: Kumazawa
authors.affiliation: Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Pharmaceutical Science, Akita University School of Medicine, Akita, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Pharmaceutical Science, Akita University School of Medicine, Akita, Japan.
authors.forename: Masatomo
authors.initials: M
authors.lastname: Miura
authors.affiliation: Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yuasa
authors.affiliation: Nephrology and Rheumatology, Akita University School of Medicine, Akita, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Komatsuda
authors.affiliation: Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Tsuchiya
authors.affiliation: Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Habuchi
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus