title: Thrombotic microangiopathy associated with tacrolimus in lung transplantation.
abstract: Thrombotic microangiopathy (TMA) is a rare complication associated with the use of calcineurin inhibitors in lung transplantation, irrespective of the underlying disease of the graft recipient. It usually occurs in incomplete forms, complicating and delaying diagnosis until damage is already irreversible. It is unrelated to time from transplantation and often presents with concomitant infection, which tends to confound diagnosis. The cases discussed here have a common causative agent and all present with concomitant infection. Treatment recommendations have changed in recent years with the introduction of plasmapheresis or, more recently, the availability of the antibody eculizumab. Notwithstanding, the most cost-effective measure is withdrawal or switching of the calcineurin inhibitor. TMA is an underdiagnosed clinical entity that should be considered in the management of transplantation patients.
authors.affiliation: Servicio de Neumología, Hospital Universitari i Politècnic la Fe, Valencia, España. Electronic address: jpreig@comv.es.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Reig Mezquida
authors.affiliation: Unidad de Trasplante Pulmonar, Hospital Universitari i Politècnic la Fe, Valencia, España.
authors.forename: Amparo Solé
authors.initials: AS
authors.lastname: Jover
authors.affiliation: Unidad de Trasplante Pulmonar, Hospital Universitari i Politècnic la Fe, Valencia, España.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ansótegui Barrera
authors.affiliation: Unidad de Trasplante Pulmonar, Hospital Universitari i Politècnic la Fe, Valencia, España.
authors.forename: Juan
authors.initials: J
authors.lastname: Escrivá Peiró
authors.affiliation: Unidad de Trasplante Pulmonar, Hospital Universitari i Politècnic la Fe, Valencia, España.
authors.forename: Maria Desamparados
authors.initials: MD
authors.lastname: Pastor Colom
authors.affiliation: Servicio de Cirugía Torácica, Hospital Universitari i Politècnic la Fe, Valencia, España.
authors.forename: Juan
authors.initials: J
authors.lastname: Pastor Guillem
mesh_terms: D000038:Abscess / Q000150:complications; D041221:Candida glabrata; D002177:Candidiasis / Q000150:complications; D003404:Creatinine / Q000097:blood; D004198:Disease Susceptibility; D057915:Drug Substitution; D004913:Erythrocytes, Abnormal; D000068338:Everolimus / Q000627:therapeutic use; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007770:L-Lactate Dehydrogenase / Q000097:blood; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D009220:Myositis / Q000150:complications; D009617:Nocardia Infections / Q000150:complications; D017713:Platelet Transfusion; D011014:Pneumonia / Q000150:complications; D011183:Postoperative Complications / Q000097:blood / Q000139:chemically induced* / Q000209:etiology / Q000628:therapy; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D057049:Thrombotic Microangiopathies / Q000097:blood / Q000139:chemically induced* / Q000209:etiology / Q000628:therapy; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D007166:Immunosuppressive Agents; D000068338:Everolimus; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D016559:Tacrolimus
keywords: Hemolytic uremic syndrome; Lung transplantation; Microangiopatía trombótica; Síndrome hemolítico urémico; Tacrolimus; Thrombotic microangiopathy; Trasplante pulmonar