J Korean Soc Transplant.  2016 Jun;30(2):94-97. 10.4285/jkstn.2016.30.2.94.

Tacrolimus-induced, Transplant-associated Thrombotic Microangiopathies after Lung Transplantation

• Choi JS
• Kim SY
• Lee JG
• Kim SJ
• Song MJ
• Yoon BR
• Kim MH
• Park MS
• Paik HC

• KMID: 2327970
• DOI: http://doi.org/10.4285/jkstn.2016.30.2.94

Abstract

We report a case of tacrolimus-induced transplant-associated thrombotic microangiopathies (TA-TMA) after lung transplantation. A 71-year-old man underwent lung transplantation secondary to idiopathic pulmonary fibrosis. After 4 months, he presented with abdominal discomfort and dyspnea, and was diagnosed with hemolytic anemia and thrombocytopenia. Tacrolimus was considered the cause of the TMA. Tacrolimus was stopped and several sessions of plasma exchange were performed immediately after diagnosis of TA-TMA. However, his platelet count did not normalize, gastrointestinal bleeding was recurrent, and severe pneumonia developed, following which he died. TA-TMA are rare but severe, life-threatening complications in lung transplant recipients. Therefore, the possibility of TA-TMA should be considered in posttransplant recipients.

Keyword

Thrombotic microangiopathies; Lung transplantation; Tacrolimus

MeSH Terms

Aged
Anemia, Hemolytic
Diagnosis
Dyspnea
Hemorrhage
Humans
Idiopathic Pulmonary Fibrosis
Lung Transplantation*
Lung*
Plasma Exchange
Platelet Count
Pneumonia
Tacrolimus
Thrombocytopenia
Thrombotic Microangiopathies*
Transplant Recipients
Tacrolimus

Figure

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  Fig. 1. Hemoglobin (Hb): baseline over 1 month prior to presentation. Plasmapheresis was started on hospital day (HOD) 21, and repeated at 12 times.

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  Fig. 2. Platelet: baseline over 1 month prior to presentation. Plasmapheresis was started on hospital day (HOD) 21, and repeated at 12 times.

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  Fig. 3. Serum Lactate dehydrogenase (LDH) level: baseline over 1 month prior to presentation. LDH elevated on hospital day (HOD) 26, then decreased by taking plasmapheresis.

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