Tacrolimus associated localized thrombotic microangiopathy developing in early stage after renal transplantation.
Calcineurin inhibitor induced thrombotic microangiopathy is a rare but well recognized complication of a renal transplantation that occurs in 1% of the patients who are on tacrolimus immunosuppression. Among the other aetiological factors of the "de-novo" Thrombotic Microangiopathy (TMA), the condition especially has to be differentiated from an antibody mediated rejection, as both have different pathogenesis, therapeutic connotations and outcomes.We report a case of a middle aged female renal transplant recipient treated with tacrolimus, who developed localised thrombotic microangiopathy in the early post transplantation period. Despite the normal trough levels of tacrolimus, a diagnosis of "Tacrolimus induced TMA" was rendered after excluding other causes of the "de-novo" TMA, which included an antibody mediated rejection, a meticulous clinico-pathological correlation and serological studies. The treatment included the substitution of tacrolimus by rapamycin, with the subsequent normalization of the renal function.
Assistant Professor, Department of Pathology,  M.S. Ramaiah Medical College ,  Bangalore, India.
Clement Wilfred
CW
Devadoss
Mysorekar
M
Vijaya V
Mahesh
M
E
Raju
R
Venkataramana S
Girish
G
M S
Calcineurin inhibitors; Renal transplantation; Tacrolimus; Thrombotic microangiopathy