Humar A, Jessurun J, Sharp H L, Gruessner R W
Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
Clin Transplant. 1998 Dec;12(6):600-1.
We herein report the first case of immunosuppression-associated thrombotic microangiopathy (TMA) in which an extrarenal graft was primarily affected by the characteristic microvascular lesions. Although TMA is a well-known complication of cyclosporine (CSA) or tacrolimus therapy in renal and extrarenal (liver, heart, lung) transplant recipients, the kidney (transplanted or native) is typically the site primarily affected. We describe a combined liver-small bowel transplant recipient who developed tacrolimus-associated TMA that affected both her transplanted small bowel and her native kidneys. Involvement of the bowel, with evidence of microvascular occlusion on biopsy, led to the development of ischemic mucosal ulcers and eventual bowel perforation. Involvement of the kidney manifested with a doubling of the recipient's baseline serum creatinine level. Significant lowering of the tacrolimus dose resulted in healing of the small bowel ulcers and return to her baseline level of renal function. Therefore, it is important to note that, in transplant recipients, TMA with microvascular occlusion may affect extrarenal sites. In small bowel transplant recipients, the result might be ischemic ulcers in the graft and eventual bowel perforation.
我们在此报告首例免疫抑制相关血栓性微血管病（TMA），其肾外移植物主要受到特征性微血管病变的影响。尽管TMA是肾移植和肾外（肝、心、肺）移植受者接受环孢素（CSA）或他克莫司治疗时众所周知的并发症，但肾脏（移植肾或天然肾）通常是主要受影响的部位。我们描述了一名肝-小肠联合移植受者，其发生了与他克莫司相关的TMA，累及她移植的小肠和天然肾。肠道受累，活检显示微血管闭塞，导致缺血性黏膜溃疡形成并最终肠穿孔。肾脏受累表现为受者基线血清肌酐水平翻倍。他克莫司剂量显著降低导致小肠溃疡愈合，肾功能恢复至基线水平。因此，需要注意的是，在移植受者中，伴有微血管闭塞的TMA可能影响肾外部位。在小肠移植受者中，结果可能是移植物出现缺血性溃疡并最终肠穿孔。
