Thrombotic Microangiopathy Following Intestinal Transplantation: A Single Center Experience |
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Authors: | D. Dierickx D. Monbaliu E. Wisanto T. Devos T. Darius J. Pirenne |
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Affiliation: | a Department of Hematology, University Hospitals Leuven, Leuven, Belgium b Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium c Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium d Department of Pathology, University Hospitals Leuven, Leuven, Belgium e Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium |
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Abstract: | BackgroundTransplant-related thrombotic microangiopathy (TMA) is a well-recognized complication of all types of transplantations. Despite its known relationship with immunosuppressive therapy, only a few cases have been reported following intestinal transplantation.MethodsWe retrospectively reviewed the medical files of nine consecutive intestinal transplant patients between 2000 and 2008.ResultsThe diagnosis of TMA was established in 3 patients (33%). At diagnosis the immunosuppressive therapy consisted of tacrolimus (n = 3), combined with azathioprine (n = 1) or sirolimus (n = 2) and steroids (n = 2). The median time between transplantation and TMA was 104 days (range, 55-167 days). Levels of ADAMTS13, a von Willebrand protease, were within normal ranges in all 3 patients. Treatment consisted of stopping/tapering of tacrolimus, together with initiation of plasma therapy, leading to complete remission in all 3 patients. During further follow-up, all 3 patients showed severe graft rejection necessitating more profound immunosuppressive therapy, leading to graft loss in 1 patient and infection-related death in the 2 others. At a median follow-up of 52 months (range, 9-100 months) all remaining TMA-free patients (n = 6) were alive with functioning grafts under minimal immunosuppression.ConclusionHerein we have described 3 intestinal transplant patients who were diagnosed with transplantation-related TMA. Despite excellent disease control the final outcomes were dismal, which clearly contrasts with the outcome among TMA-free patients, who were all well with functioning grafts at last follow-up. |
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