title: Diagnostic and management dilemma of a pancreas-kidney transplant recipient with aplastic anaemia.
abstract: We report a case of a 57-year-old woman with type I diabetes who had received a simultaneous pancreas-kidney (SPK) transplant maintained on tacrolimus, mycophenolic acid (MPA) and prednisolone. Her renal allograft failed 6 years post-transplant but she continued to have a normal functioning pancreatic allograft. Over the course of 5 years, she developed progressive bone marrow failure with repeat bone marrow aspirates demonstrating an evolution from erythroid hypoplasia to hypocellular marrow and eventual aplastic anaemia despite discontinuation of MPA and reduction of tacrolimus. She was transfusion-dependent and had frequent admissions for sepsis. Despite treatment with antithymocyte globulin and cyclosporine for aplastic anaemia, she developed fatal invasive pulmonary aspergillosis within 3 weeks of treatment. Even though the cause of aplastic anaemia is likely multifactorial, this case highlights the difficulty in balancing the need for versus the risk of ongoing immunosuppression in a SPK transplant recipient who continues to have normal pancreatic graft function.
authors.affiliation: Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Viecelli
authors.affiliation: Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Hannah
authors.initials: H
authors.lastname: Hessamodini
authors.affiliation: Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Bradley
authors.initials: B
authors.lastname: Augustson
authors.affiliation: Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Wai Hon
authors.initials: WH
authors.lastname: Lim
mesh_terms: D000741:Anemia, Aplastic / Q000139:chemically induced* / Q000188:drug therapy; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects; D016035:Pancreas Transplantation; D011239:Prednisolone / Q000009:adverse effects; D016559:Tacrolimus / Q000009:adverse effects
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus