Thrombotic Microangiopathy Associated With Tacrolimus in Lung Transplantation

• Published in: Archivos de bronconeumología (English ed.) 2015-05, Vol.51 (5), p.e23-e24
• Main Authors: Reig Mezquida, Juan Pablo, Solé Jover, Amparo, Ansótegui Barrera, Emilio, Escrivá Peiró, Juan, Pastor Colom, Maria Desamparados, Pastor Guillem, Juan
• Format: Article
• Language: English
• Subjects: Hemolytic uremic syndrome; Internal Medicine; Lung transplantation; Microangiopatía trombótica; Pulmonary/Respiratory; Síndrome hemolítico urémico; Tacrolimus; Thrombotic microangiopathy; Trasplante pulmonar
• ISSN: 1579-2129; 1579-2129
• DOI: 10.1016/j.arbr.2015.02.031

Abstract Thrombotic microangiopathy (TMA) is a rare complication associated with the use of calcineurin inhibitors in lung transplantation, irrespective of the underlying disease of the graft recipient. It usually occurs in incomplete forms, complicating and delaying diagnosis until damage is already irreversible. It is unrelated to time from transplantation and often presents with concomitant infection, which tends to confound diagnosis. The cases discussed here have a common causative agent and all present with concomitant infection. Treatment recommendations have changed in recent years with the introduction of plasmapheresis or, more recently, the availability of the antibody eculizumab. Notwithstanding, the most cost-effective measure is withdrawal or switching of the calcineurin inhibitor. TMA is an underdiagnosed clinical entity that should be considered in the management of transplantation patients.