title: De Novo Thrombotic Microangiopathy Immediately After Kidney Transplant in Patients Without Apparent Risk Factors.
abstract: Thrombotic microangiopathy refers to a spectrum of conditions that share a common underlying pathologic mechanism that result in endothelial damage and microangiopathic hemolytic anemia. De novo thrombotic microangiopathy after kidney transplant is often triggered by immunosuppressive drugs, and studies most often implicate calcineurin inhibitors and/or mammalian target of rapamycin inhibitors; however, muromonab and alemtuzumab also reportedly cause thrombotic microangiopathy. In addition, thrombotic microangiopathy may be triggered by acute antibody-mediated rejection and infections like cytomegalovirus and parvovirus. Here, we present a case series of 3 patients without any apparent risk factors (eg, acute antibody-mediated rejection) who developed de novo thrombotic microangiopathy immediately following kidney transplant, but before the introduction of calcineurin inhibitors. Two of these 3 patients were successfully managed with plasma exchange, and calcineurin inhibitors were successfully introduced without the recurrence of thrombotic microangiopathy.
authors.affiliation: Kraftsow Division of Nephrology, Einstein Medical Center Philadelphia, Philadelphia, PA 19141, USA.
authors.forename: Ankita
authors.initials: A
authors.lastname: Patel
authors.forename: John P
authors.initials: JP
authors.lastname: Knorr
authors.forename: Stalin
authors.initials: S
authors.lastname: Campos
authors.forename: Kamran
authors.initials: K
authors.lastname: Khanmoradi
authors.forename: Radi F
authors.initials: RF
authors.lastname: Zaki
authors.forename: Gitana
authors.initials: G
authors.lastname: Bradauskaite
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D010951:Plasma Exchange; D012307:Risk Factors; D057049:Thrombotic Microangiopathies / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents