Saito Mitsuru, Satoh Shigeru, Kagaya Hideaki, Tsuruta Hiroshi, Obara Takashi, Kumazawa Teruaki, Inoue Takamitsu, Inoue Kazuyuki, Miura Masatomo, Yuasa Takeshi, Komatsuda Atsushi, Tsuchiya Norihiko, Habuchi Tomonori
Department of Urology, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
Pharmaceutical Science, Akita University School of Medicine, Akita, Japan.
Clin Exp Nephrol. 2008 Aug;12(4):312-315. doi: 10.1007/s10157-008-0037-6. Epub 2008 Feb 8.
Thrombotic microangiopathy (TMA) is characterized clinically by hemolytic anemia, thrombocytopenia, and renal failure. Cyclosporine (CyA)-associated TMA is a well-documented complication, but tacrolimus (TAC)-associated TMA is rare. We report the case of a renal transplant recipient who developed TMA in the early stage after renal transplantation with a high trough level of TAC. A 56-year-old female suffering from end-stage renal disease received a living renal graft from a blood-type-identical donor. She had developed hemolytic anemia, thrombocytopenia and acute renal failure 4 days after transplantation (6 days after TAC administration). She was diagnosed as having TMA without rejection by the clinical course and pathological findings. Renal function and hemolytic parameters improved by solely a decrease of the TAC trough level. When TAC-associated TMA develops in renal transplant recipients, we recommend a decrease of the TAC trough level before changing to CyA.
血栓性微血管病（TMA）的临床特征为溶血性贫血、血小板减少和肾衰竭。环孢素（CyA）相关的TMA是一种有充分文献记载的并发症，但他克莫司（TAC）相关的TMA较为罕见。我们报告了1例肾移植受者，在肾移植术后早期出现TMA，且TAC谷值水平较高。一名56岁患有终末期肾病的女性接受了来自血型相同供体的活体肾移植。移植后4天（TAC给药后6天），她出现了溶血性贫血、血小板减少和急性肾衰竭。根据临床病程和病理结果，她被诊断为患有TMA且无排斥反应。仅通过降低TAC谷值水平，肾功能和溶血参数就得到了改善。当肾移植受者发生TAC相关的TMA时，我们建议在换用CyA之前先降低TAC谷值水平。
