title: Treatment with sirolimus ameliorates tacrolimus-induced autoimmune cytopenias after solid organ transplant.
abstract: The development of autoimmune blood cell cytopenias is a potentially life-threatening complication of solid organ transplantation, resulting from T-cell dysregulation from immunosuppressive medications. Conventional treatment with corticosteroids and IVIgG is often unsuccessful as these therapies are unlikely to overcome the T-cell dysregulation. We describe two patients who developed severe autoimmune cytopenias after solid organ transplantation. They had limited response to conventional medications, but had complete resolution of autoimmunity upon transition of immunosuppression from tacrolimus to sirolimus. Altering the immunosuppressive regimen to modify T-cell dysregulation may be beneficial for patients who develop post-transplant autoimmune disease and allow continued preservation of allograft.
authors.affiliation: Division of Hematology, Children's Hospital of Philadelphia, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. teacheyd@email.chop.edu
authors.forename: David T
authors.initials: DT
authors.lastname: Teachey
authors.forename: Tracey
authors.initials: T
authors.lastname: Jubelirer
authors.forename: H Jorge
authors.initials: HJ
authors.lastname: Baluarte
authors.forename: Amanda
authors.initials: A
authors.lastname: Wade
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Manno
mesh_terms: D000293:Adolescent; D001327:Autoimmune Diseases / Q000139:chemically induced*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects*; D010198:Pancytopenia / Q000139:chemically induced / Q000276:immunology; D020123:Sirolimus / Q000627:therapeutic use*; D016559:Tacrolimus / Q000009:adverse effects*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus