Dangerous drug interactions leading to hemolytic uremic syndrome following lung transplantation.
BACKGROUND
To report our experience of a rather uncommon drug interaction, resulting in hemolytic uremic syndrome (HUS).


METHODS
Two consecutive cases of hemolytic uremic syndrome were diagnosed in our service. In both patients the use of macrolides in patients taking Tacrolimus, resulted in high levels of Tacrolimus.


RESULTS
The first patient was a 48 years old female with Bilateral emphysema. She underwent Single Sequential Lung Transplantation. She developed reperfusion injury requiring prolonged stay. Tacrolimus introduced (Day 51). The patient remained well up till 5 months later; Erythromycin commenced for chest infection. High Tacrolimus levels and a clinical diagnosis of HUS were made. She was treated with plasmapheresis successfully. The second case was a 57 years old female with Emphysema & A1 Antithrypsin deficiency. She underwent Right Single Lung Transplantation. A2 rejection with mild Obliterative Bronchiolitis diagnosed 1 year later and she switched to Tacrolimus. She was admitted to her local Hospital two and a half years later with right middle lobe consolidation. The patient commenced on amoxicillin and clarithromycin. Worsening renal indices, high Tacrolimus levels, hemolytic anemia & low Platelets were detected. HUS diagnosed & treated with plasmapheresis.


CONCLUSIONS
There are 21 cases of HUS following lung transplantation in the literature that may have been induced by high tacrolimus levels. Macrolides in patients taking Cyclosporin or Tacrolimus lead to high levels. Mechanism of action could be glomeruloconstrictor effect with reduced GFR increased production of Endothelin-1 and increased Platelet aggregation.
Parissis
Haralabos
H
Cardiothoracic Department, Royal Victoria Hospital, Grosvernor Rd, Belfast, BT12 6BA, Nothern Ireland. hparissis@yahoo.co.uk
Gould
Kate
K
Dark
John
J
D004347:Drug Interactions; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000494:pharmacology; D016040:Lung Transplantation; D018942:Macrolides / Q000009:adverse effects* / Q000494:pharmacology; D008875:Middle Aged; D011656:Pulmonary Emphysema / Q000601:surgery*; D016559:Tacrolimus / Q000009:adverse effects* / Q000494:pharmacology
D007166:Immunosuppressive Agents; D018942:Macrolides; D016559:Tacrolimus
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