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Nephrol Dial Transplant (2002) 17: 1524-1526
© 2002 European Renal Association-European Dialysis and Transplant Association

Case Reports

Sirolimus-based immunosuppression for transplant-associated thrombotic microangiopathy

Cedric Edwards1, Andrew House2, Vahakn Shahinian2 and Greg Knoll1,

1 Division of Nephrology, Department of Medicine, Kidney Research Centre, University of Ottawa, Ottawa, Ontario, Canada and 2 Division of Nephrology, Department of Medicine, University of Western Ontario, London, Ontario, Canada

The first 10% of the full text of this article appears below.



   Introduction
 
Thrombotic microangiopathy (TMA) is a well-recognized complication of solid organ transplantation. Both calcineurin inhibitors cyclosporine [1] and tacrolimus [2] have been associated with TMA. Treatment strategies for TMA have included plasmapheresis [1,2], calcineurin inhibitor dose reduction [1,2], calcineurin inhibitor withdrawal [1,2], and conversion from one calcineurin inhibitor to the other [3]. However, calcineurin inhibitor dose reduction or discontinuation increases the risk of acute allograft rejection and recurrent TMA has been described in patients that were converted from cyclosporine to tacrolimus [4,5]. We present two cases of biopsy-proven transplant-associated TMA that were successfully treated by discontinuation of tacrolimus followed by the use of sirolimus, mycophenolate mofetil (MMF) and prednisone for the prevention of allograft rejection.



   Case 1
 
A 42-year-old white male with end-stage . . . [Full Text of this Article]



   Case 2
 


   Discussion
 

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