Successful sirolimus rescue in tacrolimus-induced thrombotic microangiopathy after living-related liver transplantation

Pediatr Transplant. 2012 Sep;16(6):E261-4. doi: 10.1111/j.1399-3046.2011.01601.x. Epub 2011 Nov 8.

Abstract

TMA is a rare complication of tacrolimus. Disruption of endothelial cells, platelet aggregation, and intravascular mechanical fragmentation of red cells are core mechanisms of injury; however, exact pathways of toxicity are not clear. The clinical presentation may vary but TMA is a potentially life-threatening condition usually demanding aggressive treatment. We present the case of TMA in a child after living-related liver transplantation (LRLTx) on tacrolimus-based immunosuppressive regiment successfully converted to sirolimus.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Hemolytic / complications
  • Anemia, Hemolytic / therapy
  • Biopsy
  • Erythrocytes / drug effects
  • Female
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use*
  • Infant
  • Liver Failure / complications*
  • Liver Failure / therapy*
  • Liver Transplantation / methods*
  • Living Donors
  • Platelet Aggregation / drug effects
  • Sirolimus / therapeutic use*
  • Tacrolimus / adverse effects*
  • Tacrolimus / toxicity
  • Thrombotic Microangiopathies / chemically induced*
  • Thrombotic Microangiopathies / complications*
  • Treatment Outcome

Substances

  • Immunosuppressive Agents
  • Sirolimus
  • Tacrolimus