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Combination of everolimus with calcineurin inhibitor medication resulted in post-transplant haemolytic uraemic syndrome in lung transplant recipients-a case series

Background. Post-transplant haemolytic uraemic syndrome (HUS) is a rare but serious disease with a high mortality rate, when left untreated. Immunosuppressive drugs like calcineurin inhibitors as well as mammalian target of rapamycin inhibitors have been reported as causative agents for post-transpl...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2011-09, Vol.26 (9), p.3032-3038
Main Authors: Lovric, Svjetlana, Kielstein, Jan T., Kayser, Daniel, Bröcker, Verena, Becker, Jan U., Hiss, Marcus, Schiffer, Mario, Sommerwerck, Urte, Haller, Hermann, Strüber, Martin, Welte, Tobias, Gottlieb, Jens
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cited_by cdi_FETCH-LOGICAL-c382t-d0f28749a6027466792c1deef2a19bf2704dc19ca3e5ebf6dda6680ce3b7606b3
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container_end_page 3038
container_issue 9
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container_title Nephrology, dialysis, transplantation
container_volume 26
creator Lovric, Svjetlana
Kielstein, Jan T.
Kayser, Daniel
Bröcker, Verena
Becker, Jan U.
Hiss, Marcus
Schiffer, Mario
Sommerwerck, Urte
Haller, Hermann
Strüber, Martin
Welte, Tobias
Gottlieb, Jens
description Background. Post-transplant haemolytic uraemic syndrome (HUS) is a rare but serious disease with a high mortality rate, when left untreated. Immunosuppressive drugs like calcineurin inhibitors as well as mammalian target of rapamycin inhibitors have been reported as causative agents for post-transplant HUS. Methods. A retrospective observational study was performed in lung transplant recipients, who took part in an interventional study, in two centres. Haemoglobin, platelets, creatinine and lactate dehydrogenase levels were monitored during routine follow-up and patients with deteriorating kidney function were screened for post-transplant HUS. All cases of post-transplant HUS were identified by clinical and laboratory findings. Outcome was recorded until 6 months after diagnosis. Results. A total of 2188 visits in 512 lung transplant recipients (outpatients) were analysed. Out of those, 126 patients took part in an interventional study. In this study, 67 were switched to everolimus in combination with calcineurin inhibitors 4 weeks after transplantation, 59 patients remained on standard immunosuppression (calcineurin inhibitors, mycophenolate mofetil and prednisolone). Five cases of post-transplant HUS were identified in the everolimus group. None of the patients had evidence of gastrointestinal infection or preexisting renal disease. Post-transplant HUS was treated with therapeutic plasma exchange and methylprednisolone pulse therapy. Everolimus was discontinued in all five patients. This treatment regimen led to normalization of haemoglobin, platelets and improved renal function. Two patients developed end-stage renal failure and were maintained on haemodialysis. One patient died due to multiorgan failure. Improvement of renal function was seen in two patients. No further cases were recorded in patients without everolimus during the study period. Conclusions. Our data should raise the awareness of post-transplant HUS in lung transplant recipients. Post-transplant HUS is a rare disease, but it is a serious cause of acute renal failure in lung transplant recipients treated with a combination of everolimus and calcineurin inhibitors.
doi_str_mv 10.1093/ndt/gfq842
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Post-transplant haemolytic uraemic syndrome (HUS) is a rare but serious disease with a high mortality rate, when left untreated. Immunosuppressive drugs like calcineurin inhibitors as well as mammalian target of rapamycin inhibitors have been reported as causative agents for post-transplant HUS. Methods. A retrospective observational study was performed in lung transplant recipients, who took part in an interventional study, in two centres. Haemoglobin, platelets, creatinine and lactate dehydrogenase levels were monitored during routine follow-up and patients with deteriorating kidney function were screened for post-transplant HUS. All cases of post-transplant HUS were identified by clinical and laboratory findings. Outcome was recorded until 6 months after diagnosis. Results. A total of 2188 visits in 512 lung transplant recipients (outpatients) were analysed. Out of those, 126 patients took part in an interventional study. In this study, 67 were switched to everolimus in combination with calcineurin inhibitors 4 weeks after transplantation, 59 patients remained on standard immunosuppression (calcineurin inhibitors, mycophenolate mofetil and prednisolone). Five cases of post-transplant HUS were identified in the everolimus group. None of the patients had evidence of gastrointestinal infection or preexisting renal disease. Post-transplant HUS was treated with therapeutic plasma exchange and methylprednisolone pulse therapy. Everolimus was discontinued in all five patients. This treatment regimen led to normalization of haemoglobin, platelets and improved renal function. Two patients developed end-stage renal failure and were maintained on haemodialysis. One patient died due to multiorgan failure. Improvement of renal function was seen in two patients. No further cases were recorded in patients without everolimus during the study period. Conclusions. Our data should raise the awareness of post-transplant HUS in lung transplant recipients. Post-transplant HUS is a rare disease, but it is a serious cause of acute renal failure in lung transplant recipients treated with a combination of everolimus and calcineurin inhibitors.</description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfq842</identifier><identifier>PMID: 21310739</identifier><identifier>CODEN: NDTREA</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adult ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Calcineurin Inhibitors ; Cyclosporine - therapeutic use ; Emergency and intensive care: renal failure. Dialysis management ; Everolimus ; Female ; Follow-Up Studies ; Graft Rejection - prevention &amp; control ; Hemolytic-Uremic Syndrome - etiology ; Humans ; Immunosuppressive Agents - therapeutic use ; Intensive care medicine ; Lung Diseases - complications ; Lung Diseases - therapy ; Lung Transplantation - adverse effects ; Male ; Medical sciences ; Middle Aged ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Sirolimus - analogs &amp; derivatives ; Sirolimus - therapeutic use ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Survival Rate</subject><ispartof>Nephrology, dialysis, transplantation, 2011-09, Vol.26 (9), p.3032-3038</ispartof><rights>The Author 2011. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com 2011</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c382t-d0f28749a6027466792c1deef2a19bf2704dc19ca3e5ebf6dda6680ce3b7606b3</citedby><cites>FETCH-LOGICAL-c382t-d0f28749a6027466792c1deef2a19bf2704dc19ca3e5ebf6dda6680ce3b7606b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=24565623$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21310739$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lovric, Svjetlana</creatorcontrib><creatorcontrib>Kielstein, Jan T.</creatorcontrib><creatorcontrib>Kayser, Daniel</creatorcontrib><creatorcontrib>Bröcker, Verena</creatorcontrib><creatorcontrib>Becker, Jan U.</creatorcontrib><creatorcontrib>Hiss, Marcus</creatorcontrib><creatorcontrib>Schiffer, Mario</creatorcontrib><creatorcontrib>Sommerwerck, Urte</creatorcontrib><creatorcontrib>Haller, Hermann</creatorcontrib><creatorcontrib>Strüber, Martin</creatorcontrib><creatorcontrib>Welte, Tobias</creatorcontrib><creatorcontrib>Gottlieb, Jens</creatorcontrib><title>Combination of everolimus with calcineurin inhibitor medication resulted in post-transplant haemolytic uraemic syndrome in lung transplant recipients-a case series</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol Dial Transplant</addtitle><description>Background. Post-transplant haemolytic uraemic syndrome (HUS) is a rare but serious disease with a high mortality rate, when left untreated. Immunosuppressive drugs like calcineurin inhibitors as well as mammalian target of rapamycin inhibitors have been reported as causative agents for post-transplant HUS. Methods. A retrospective observational study was performed in lung transplant recipients, who took part in an interventional study, in two centres. Haemoglobin, platelets, creatinine and lactate dehydrogenase levels were monitored during routine follow-up and patients with deteriorating kidney function were screened for post-transplant HUS. All cases of post-transplant HUS were identified by clinical and laboratory findings. Outcome was recorded until 6 months after diagnosis. Results. A total of 2188 visits in 512 lung transplant recipients (outpatients) were analysed. Out of those, 126 patients took part in an interventional study. In this study, 67 were switched to everolimus in combination with calcineurin inhibitors 4 weeks after transplantation, 59 patients remained on standard immunosuppression (calcineurin inhibitors, mycophenolate mofetil and prednisolone). Five cases of post-transplant HUS were identified in the everolimus group. None of the patients had evidence of gastrointestinal infection or preexisting renal disease. Post-transplant HUS was treated with therapeutic plasma exchange and methylprednisolone pulse therapy. Everolimus was discontinued in all five patients. This treatment regimen led to normalization of haemoglobin, platelets and improved renal function. Two patients developed end-stage renal failure and were maintained on haemodialysis. One patient died due to multiorgan failure. Improvement of renal function was seen in two patients. No further cases were recorded in patients without everolimus during the study period. Conclusions. Our data should raise the awareness of post-transplant HUS in lung transplant recipients. Post-transplant HUS is a rare disease, but it is a serious cause of acute renal failure in lung transplant recipients treated with a combination of everolimus and calcineurin inhibitors.</description><subject>Adult</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Calcineurin Inhibitors</subject><subject>Cyclosporine - therapeutic use</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Everolimus</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft Rejection - prevention &amp; control</subject><subject>Hemolytic-Uremic Syndrome - etiology</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Intensive care medicine</subject><subject>Lung Diseases - complications</subject><subject>Lung Diseases - therapy</subject><subject>Lung Transplantation - adverse effects</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Complications</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Sirolimus - analogs &amp; derivatives</subject><subject>Sirolimus - therapeutic use</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Survival Rate</subject><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNp9kc2KFDEUhYMoTju68QEkGxGEcpJUVaqylMY_GHCj6yKV3ExHqpKa3MShn8cXNUO3jitX58L97g_nEPKSs3ecqfYq2Hx1427HTjwiO95J1oh27B-TXW3yhvVMXZBniD8YY0oMw1NyIXjL2dCqHfm1j-vsg84-BhodhZ-Q4uLXgvTO5wM1ejE-QEk-UB8OfvY5JrqC9eY0kwDLksHWLt0i5iYnHXBbdMj0oGGNyzF7Q0uqdVU8BpviCvf4UsIN_QdPYPzmIWRsdD2MQBGSB3xOnji9ILw46yX5_vHDt_3n5vrrpy_799eNaUeRG8ucGIdOacnE0Ek5KGG4BXBCczU7MbDOGq6MbqGH2UlrtZQjM9DOg2Rybi_Jm9PeLcXbApin1aOBpT4HseA0KqG6YRxZJd-eSJMiYgI3bcmvOh0nzqb7TKaayXTKpMKvzmvLXI37i_4JoQKvz4DG6rerjhiPD1zXy16K9oGLZfvfwd8hC6e5</recordid><startdate>20110901</startdate><enddate>20110901</enddate><creator>Lovric, Svjetlana</creator><creator>Kielstein, Jan T.</creator><creator>Kayser, Daniel</creator><creator>Bröcker, Verena</creator><creator>Becker, Jan U.</creator><creator>Hiss, Marcus</creator><creator>Schiffer, Mario</creator><creator>Sommerwerck, Urte</creator><creator>Haller, Hermann</creator><creator>Strüber, Martin</creator><creator>Welte, Tobias</creator><creator>Gottlieb, Jens</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110901</creationdate><title>Combination of everolimus with calcineurin inhibitor medication resulted in post-transplant haemolytic uraemic syndrome in lung transplant recipients-a case series</title><author>Lovric, Svjetlana ; Kielstein, Jan T. ; Kayser, Daniel ; Bröcker, Verena ; Becker, Jan U. ; Hiss, Marcus ; Schiffer, Mario ; Sommerwerck, Urte ; Haller, Hermann ; Strüber, Martin ; Welte, Tobias ; Gottlieb, Jens</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c382t-d0f28749a6027466792c1deef2a19bf2704dc19ca3e5ebf6dda6680ce3b7606b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Calcineurin Inhibitors</topic><topic>Cyclosporine - therapeutic use</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Everolimus</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft Rejection - prevention &amp; control</topic><topic>Hemolytic-Uremic Syndrome - etiology</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Intensive care medicine</topic><topic>Lung Diseases - complications</topic><topic>Lung Diseases - therapy</topic><topic>Lung Transplantation - adverse effects</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Complications</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Sirolimus - analogs &amp; derivatives</topic><topic>Sirolimus - therapeutic use</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lovric, Svjetlana</creatorcontrib><creatorcontrib>Kielstein, Jan T.</creatorcontrib><creatorcontrib>Kayser, Daniel</creatorcontrib><creatorcontrib>Bröcker, Verena</creatorcontrib><creatorcontrib>Becker, Jan U.</creatorcontrib><creatorcontrib>Hiss, Marcus</creatorcontrib><creatorcontrib>Schiffer, Mario</creatorcontrib><creatorcontrib>Sommerwerck, Urte</creatorcontrib><creatorcontrib>Haller, Hermann</creatorcontrib><creatorcontrib>Strüber, Martin</creatorcontrib><creatorcontrib>Welte, Tobias</creatorcontrib><creatorcontrib>Gottlieb, Jens</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lovric, Svjetlana</au><au>Kielstein, Jan T.</au><au>Kayser, Daniel</au><au>Bröcker, Verena</au><au>Becker, Jan U.</au><au>Hiss, Marcus</au><au>Schiffer, Mario</au><au>Sommerwerck, Urte</au><au>Haller, Hermann</au><au>Strüber, Martin</au><au>Welte, Tobias</au><au>Gottlieb, Jens</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Combination of everolimus with calcineurin inhibitor medication resulted in post-transplant haemolytic uraemic syndrome in lung transplant recipients-a case series</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><addtitle>Nephrol Dial Transplant</addtitle><date>2011-09-01</date><risdate>2011</risdate><volume>26</volume><issue>9</issue><spage>3032</spage><epage>3038</epage><pages>3032-3038</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><coden>NDTREA</coden><abstract>Background. Post-transplant haemolytic uraemic syndrome (HUS) is a rare but serious disease with a high mortality rate, when left untreated. Immunosuppressive drugs like calcineurin inhibitors as well as mammalian target of rapamycin inhibitors have been reported as causative agents for post-transplant HUS. Methods. A retrospective observational study was performed in lung transplant recipients, who took part in an interventional study, in two centres. Haemoglobin, platelets, creatinine and lactate dehydrogenase levels were monitored during routine follow-up and patients with deteriorating kidney function were screened for post-transplant HUS. All cases of post-transplant HUS were identified by clinical and laboratory findings. Outcome was recorded until 6 months after diagnosis. Results. A total of 2188 visits in 512 lung transplant recipients (outpatients) were analysed. Out of those, 126 patients took part in an interventional study. In this study, 67 were switched to everolimus in combination with calcineurin inhibitors 4 weeks after transplantation, 59 patients remained on standard immunosuppression (calcineurin inhibitors, mycophenolate mofetil and prednisolone). Five cases of post-transplant HUS were identified in the everolimus group. None of the patients had evidence of gastrointestinal infection or preexisting renal disease. Post-transplant HUS was treated with therapeutic plasma exchange and methylprednisolone pulse therapy. Everolimus was discontinued in all five patients. This treatment regimen led to normalization of haemoglobin, platelets and improved renal function. Two patients developed end-stage renal failure and were maintained on haemodialysis. One patient died due to multiorgan failure. Improvement of renal function was seen in two patients. No further cases were recorded in patients without everolimus during the study period. Conclusions. Our data should raise the awareness of post-transplant HUS in lung transplant recipients. Post-transplant HUS is a rare disease, but it is a serious cause of acute renal failure in lung transplant recipients treated with a combination of everolimus and calcineurin inhibitors.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>21310739</pmid><doi>10.1093/ndt/gfq842</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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ispartof Nephrology, dialysis, transplantation, 2011-09, Vol.26 (9), p.3032-3038
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source Oxford Journals Online
subjects Adult
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Calcineurin Inhibitors
Cyclosporine - therapeutic use
Emergency and intensive care: renal failure. Dialysis management
Everolimus
Female
Follow-Up Studies
Graft Rejection - prevention & control
Hemolytic-Uremic Syndrome - etiology
Humans
Immunosuppressive Agents - therapeutic use
Intensive care medicine
Lung Diseases - complications
Lung Diseases - therapy
Lung Transplantation - adverse effects
Male
Medical sciences
Middle Aged
Postoperative Complications
Prognosis
Retrospective Studies
Sirolimus - analogs & derivatives
Sirolimus - therapeutic use
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Survival Rate
title Combination of everolimus with calcineurin inhibitor medication resulted in post-transplant haemolytic uraemic syndrome in lung transplant recipients-a case series
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