title: A case of tacrolimus-associated thrombotic microangiopathy after ABO-blood-type-incompatible renal transplantation.
abstract: De novo thrombotic microangiopathy(TMA) is most commonly triggered by calcineurin inhibitors (CNI) and the prognosis is less severe than with recurrent TMA. However, it is difficult to distinguish de novo TMA from CNI toxicity and acute antibody-mediated rejection(AMR) soon after renal transplantation. We present a case of tacrolimus-associated TMA soon after ABO blood type incompatible renal transplantation that was difficult to differentiate from acute AMR. On day 9 his urine output decreased dramatically and the Scr level increased. His anti-blood type A antibody titer increased to ×16 postopratively and the tacrolimus trough level was higher than in our immunosuppressive regimen. Although we gave priority to anti-AMR treatment, adequate dose adjustment of tacrolimus after tacrolimus nephrotoxicity was diagnosed from graft biopsy could correct allograft dysfunction.
authors.affiliation: Kidney Center, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan. asamit@nagoya2.jrc.or.jp
authors.forename: Asami
authors.initials: A
authors.lastname: Takeda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ohtsuka
authors.forename: Keij
authors.initials: K
authors.lastname: Horike
authors.forename: Daizyo
authors.initials: D
authors.lastname: Inaguma
authors.forename: Norihiko
authors.initials: N
authors.lastname: Goto
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Watarai
authors.forename: Kazuharu
authors.initials: K
authors.lastname: Uchida
authors.forename: Kunio
authors.initials: K
authors.lastname: Morozumi
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016559:Tacrolimus / Q000009:adverse effects*; D057049:Thrombotic Microangiopathies / Q000139:chemically induced*
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D016559:Tacrolimus