title: Tacrolimus (FK506) associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in lung transplant salvage with a plasmapheresis and cyclosporin.
abstract: Thrombotic microangiopathy (TMA), a microvascular hemolytic disorder is a rare, but well described complication in organ transplant patients receiving immunosuppressant drugs. We report a 56-year-old female with a history of left lung transplant that presented to the hospital with microangiopathic hemolytic anemia and thrombocytopenia while receiving tacrolimus (FK 506) for 36 months. The patient was diagnosed with tacrolimus-induced TTP/HUS and started on daily plasmapheresis, and replacement of FK506 with cyclosporine. After thirteen plasmapheresis procedures, her platelet count, lactate dehydrogenase, and hematocrit were normalized. The ADAMTS-13 activity was subnormal and no inhibitory antibody was detected. The combination of daily plasmapheresis with fresh frozen plasma as a source of ADAMTS-13 and cyclosporine may be used as a rescue therapy in patients with FK506-induced TTP/HUS.
authors.affiliation: Department of Laboratory Medicine, Geisinger Medical Center, USA.
authors.forename: Fouad N
authors.initials: FN
authors.lastname: Boctor
mesh_terms: D051722:ADAM Proteins / Q000097:blood; D000071120:ADAMTS13 Protein; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000097:blood / Q000139:chemically induced / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016040:Lung Transplantation; D008875:Middle Aged; D010956:Plasmapheresis; D011697:Purpura, Thrombotic Thrombocytopenic / Q000097:blood / Q000139:chemically induced / Q000628:therapy*; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human; D016559:Tacrolimus