title: Thrombotic microangiopathy following pancreas after kidney transplants.
abstract: Advances in immunosuppressive therapy and refinement in surgical techniques have allowed pancreas after kidney (PAK) transplantation to become a viable therapeutic option for patients with brittle type I diabetic recipients of a living donor or previous deceased kidney alone transplant. Although maintenance immunosuppressive therapy is not significantly changed after the addition of a pancreas, a temporary booster in immunosuppressive therapy and an increase in the dose of calcineurin inhibitor (CNI) are required after PAK transplantation. The latter has been implicated in the observed variable decline in kidney allograft function. We herein report two cases of kidney allograft dysfunction following PAK transplant due to biopsy-proven transplant, thrombotic microangiopathy (TMA). Whether PAK transplantation pre-disposes a subset of patients to the development of post-transplant TMA is not known. Diagnostic kidney biopsies should be considered in PAK transplant recipients with worsening kidney allograft function.
authors.affiliation: Department of Surgery and Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Lipshutz
authors.forename: Phuong-Chi T
authors.initials: PC
authors.lastname: Pham
authors.forename: Mark R
authors.initials: MR
authors.lastname: Ghobrial
authors.forename: William D
authors.initials: WD
authors.lastname: Wallace
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Miller
authors.forename: Phuong-Thu T
authors.initials: PT
authors.lastname: Pham
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors; D002196:Capillaries / Q000473:pathology*; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007678:Kidney Glomerulus / Q000187:drug effects / Q000473:pathology; D016030:Kidney Transplantation; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects; D010956:Plasmapheresis; D051437:Renal Insufficiency / Q000209:etiology* / Q000628:therapy; D014652:Vascular Diseases / Q000209:etiology* / Q000473:pathology
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine