Cyclosporine withdrawal in post-renal transplant thrombotic microangiopathy

• Published in: Clinical transplantation Vol. 20; no. 1; pp. 43 - 47
• Main Authors: Manzoor, K, Ahmed, E, Akhtar, F, Kazi, JI, Naqvi, SA, Rizvi, SAH
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2006; Blackwell
• Subjects: Adolescent; Adult; Azathioprine - administration & dosage; Biological and medical sciences; Biopsy; cyclosporine; Cyclosporine - adverse effects; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; hemolytic uremic syndrome; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - immunology; Male; Medical sciences; Microcirculation; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Postoperative Period; Renal failure; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thrombosis - chemically induced; thrombotic microangiopathy; Tissue, organ and graft immunology; transplantation; Cardiovascular disease; Hemopathy; Transplantation; Homotransplantation; Thrombohemolytic microangiopathy; Vascular disease; Hemolytic anemia; Surgery; Treatment withdrawal; Graft; Ciclosporin; thrombotic microangiopathy; Kidney disease; Postoperative; Thrombocytopenia; cyclosporine; Urinary system disease; Hemolytic uremic syndrome; Acute; Medicine; Platelet; Treatment; Urinary system; Renal failure; Immunosuppressive agent
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2005.00438.x

:  Introduction:  Thrombotic microangiopathy (TMA) is a well known complication of cyclosporine (CsA)‐treated renal transplantation but optimum treatment strategies are not clearly defined. Patients and methods:  All patients transplanted between January 1996 and December 2001 at our center who had biopsy‐proven TMA and in whom CsA was withdrawn were studied retrospectively. Results:  The TMA was found in nine of 688 patients (1.3%). All except one donor were living related. HLA matching was one haplotype in all except one where both haplotypes were different. There were five males and four females and the mean age was 24.9 ± 9 yr. All of them developed TMA within 3 months of transplant. Five of nine had evidence of microangiopathic hemolysis on peripheral film. Serum creatinine at the time of diagnosis of TMA was 3.1 ± 1.3 mg/dL. Cyclosporine was discontinued in all and mycophenolate mofetil was substituted for azathioprine. No episode of acute rejection occurred after CsA withdrawal. Graft function did not improve in four who eventually became dialysis‐dependent after a mean duration of 12.6 ± 8.3 months. Remaining patients showed stabilization or improvement in function and all had serum creatinine below 2 mg/dL after a mean follow up of 24 months. Conclusion:  The CsA withdrawal in cases with TMA at a stage when significant functional deterioration has not taken place can salvage the graft.