title: Thrombotic microangiopathy caused by oral contraceptives in a kidney transplant recipient.
abstract: Thrombotic microangiopathy (TMA) after kidney transplantation has various aetiologies, including acute antibody-mediated rejection, bacterial or viral infection and immunosuppressive drugs, particularly calcineurin inhibitors. We present the case of a 28-year-old woman who developed TMA 30 months after the transplantation of an ABO-incompatible kidney from a living unrelated donor. The patient developed a sudden onset of allograft renal dysfunction and became uremic. She was transferred to our institution from a community hospital with strongly suspected acute allograft rejection. Intensive treatments for both T- and B-cell mediated acute rejection, including steroid pulse therapy, double-filtration plasmapheresis, antithymocyte globulin (1.5 mg/kg × 14 days) and rituximab (100 mg), were initiated during haemodialysis. However, her renal allograft function did not improve. Histopathological analysis 8 days after the treatment indicated TMA, despite the absence of apparent acute T-cell- or acute antibody-mediated rejection. There were no symptoms of infectious diseases, such as intestinal haemorrhagic colitis or viral infection. We concluded that the use of oral contraceptives, which had been initiated 3 weeks before TMA onset for the treatment of irregular vaginal bleeding, was the aetiologic agent.
authors.affiliation: Department of Transplant Surgery, International University of Health and Welfare, Atami Hospital, Shizuoka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shirai
authors.affiliation: Department of Transplant Surgery, International University of Health and Welfare, Atami Hospital, Shizuoka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Yashima
authors.affiliation: Department of Transplant Surgery, International University of Health and Welfare, Atami Hospital, Shizuoka, Japan.
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Tojimbara
authors.affiliation: Department of Anatomy, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Kazuho
authors.initials: K
authors.lastname: Honda
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D064591:Allografts; D001706:Biopsy; D001787:Blood Group Incompatibility / Q000276:immunology; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D019304:Ethinyl Estradiol-Norgestrel Combination / Q000009:adverse effects*; D005260:Female; D006648:Histocompatibility; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D012307:Risk Factors; D057049:Thrombotic Microangiopathies / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D003278:Contraceptives, Oral, Hormonal; D019304:Ethinyl Estradiol-Norgestrel Combination
keywords: graft loss; kidney; oral contraceptives; thrombotic microangiopathy; transplantation