Nephrol Dial Transplant Vol. 20 No. 1 © ERA-EDTA 2005; all rights reserved
Case Report
De novo thrombotic microangiopathy following treatment with sirolimus: report of two cases
1 Division of Nephrology, Department of Medicine, 2 Department of Surgery and 3 Department of Pathology, Columbia University, College of Physicians and Surgeons, New York, NY, USA
Correspondence and offprint requests to: Glen S. Markowitz, MD, Department of Pathology, Columbia University Medical Center, 630 West 168th Street, Room 14-224, New York, NY 10032, USA. Email: gsm17@columbia.edu
Keywords: calcineurin inhibitor; de novo thrombotic microangiopathy; renal transplantation; sirolimus
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Introduction |
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The term thrombotic microangiopathy (TMA) has been applied to a diverse group of conditions that share the common pathomechanism of endothelial damage. TMA is a recognized complication of solid organ transplantation. The majority of cases represent de novo TMA, which occurs in
2.8–3.5% of renal transplant recipients and is associated with a 22% rate of graft loss [1]. The rate of graft loss is strongly influenced by whether the TMA is systemic or renal limited (38 vs 0% graft loss, respectively) [1].
Treatment with calcineurin inhibitors (CNIs) is a well-established risk factor for the development of de novo TMA. A recent, large analysis of the United States Renal Data System (USRDS) and Medicare claims identified multiple additional risk factors including younger recipient age, older donor age, female gender of the recipient, longer duration of dialysis before transplantation, previous renal transplant, delayed graft function (DGF), allograft rejection,
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Methods |
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Case 1 |
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Clinical history
Renal allograft biopsy findings
Clinical follow-up
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Case 2 |
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Clinical history
Renal allograft biopsy findings
Clinical follow-up
Results
Discussion
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