Thrombotic microangiopathy associated with tacrolimus in lung transplantation.

Autors de IIS La Fe

• Juan Pablo Reig Mezquida

  Autor

• Amparo Solé Jover

  Autor

• Emilio Ansótegui Barrera

  Autor

• Dolores Escrivá Peiró

  Autor

• María Desamparados Pastor Colom

  Autor

• Juan Pastor Guillem

  Autor

Grups d'Investigació

• Infección Grave

  

  Investigador Principal

  María Ángeles Tormo Mas

• Infecciones Respiratorias

  Investigador Principal

  Raúl Méndez Ocaña

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.

Keywords

• Hemolytic uremic syndrome; Lung transplantation; Microangiopatia trombotica; Sindrome hemolitico uremico; Tacrolimus; Thrombotic microangiopathy; Trasplante pulmonar