Rangel, Érika B.;
Gonzalez, Adriano M.;
Linhares, Marcelo M.;
Araújo, Sérgio R.R.;
Franco, Marcello F.;
De Sá, João R.;
Pestana, José O.M.;
Melaragno, Cláudio S.
Thrombotic microangiopathy after simultaneous pancreas–kidney transplantation
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Media type:
E-Article
Title:
Thrombotic microangiopathy after simultaneous pancreas–kidney transplantation
Contributor:
Rangel, Érika B.;
Gonzalez, Adriano M.;
Linhares, Marcelo M.;
Araújo, Sérgio R.R.;
Franco, Marcello F.;
De Sá, João R.;
Pestana, José O.M.;
Melaragno, Cláudio S.
Published:
Wiley, 2007
Published in:
Clinical Transplantation, 21 (2007) 2, Seite 241-245
Description:
Abstract: Thrombotic microangiopathy (TMA) is rare after transplantation and is associated with a high incidence of kidney graft dysfunction. Between December 2000 and March 2006, 136 simultaneous pancreas–kidney transplantations were performed with an incidence of TMA of 5.1% (71.4% localized to kidney allograft). All cases were diagnosed during the first three months and were attributed to tacrolimus; 74% were women. Systemic TMA presented higher values of lactate dehydrogenase (2658 ± 659 U/L vs. 1331 ± 473 U/L, p = 0.04) and a greater decrease in hematocrit (45.8 ± 17.7% vs. 19.2 ± 6%, p = 0.02) than in localized TMA. Acute kidney rejection complicated almost 90% of the cases with 43% of kidney graft lost. Tacrolimus was switched to sirolimus and fresh‐frozen plasma was administered. Creatinine clearance after a mean follow‐up of two yr was 100.7 mL/min/1.73 m2 and 57.9 mL/min/1.73 m2 in patients with systemic and localized TMA, respectively. In conclusion, sirolimus is an alternative to TMA associated with tacrolimus.