مورد إلكتروني
De novo thrombotic microangiopathy following simultaneous pancreas and kidney transplantation managed with eculizumab.
| العنوان: | De novo thrombotic microangiopathy following simultaneous pancreas and kidney transplantation managed with eculizumab. |
|---|---|
| بيانات النشر: | Blackwell Publishing (E-mail: info@asia.blackpublishing.com.au) Australia 2017-03-13 |
| تفاصيل مُضافة: | Shochet L. Mulley W. Ta J. Kanellis J. Simpson I. |
| نوع الوثيقة: | Electronic Resource |
| مستخلص: | Thrombotic microangiopathy (TMA) is a well-recognised complication following transplantation, often due to an underlying genetic predisposition, medications or rejection. The use of eculizumab in these settings has been previously described, but its role still remains to be clarified. A 45-year-old man, with a history of type 1 diabetes mellitus and subsequent end-stage kidney failure, presented for a simultaneous pancreas-kidney transplant. Immunologically, he was well matched with the donor, and he received standard induction immunosuppression including tacrolimus. His early transplant course was complicated by Haemophilus parainfluenzae paronychia and a Pseudomonas aeruginosa catheter-associated urinary tract infection. Within 1 week, he developed thrombotic microangiopathy with significant renal dysfunction and eventual dialysis dependence, without evidence of transplant rejection on biopsy. He was also noted to have antiphospholipid antibodies in moderate titres. The TMA did not resolve despite cessation of tacrolimus, and he was subsequently commenced on eculizumab. The patient achieved a partial remission from TMA, with ongoing biochemical evidence of haemolysis, although now with stable graft function, despite significant damage. His transplanted pancreas remained seemingly unaffected by TMA, and continues to function well. This case describes an unusual presentation of TMA post-transplantation and is the only described case of eculizumab use following pancreas-kidney transplant. It remains unclear in this case what the likely precipitant for TMA was, although it seems to be, at least in part, controlled by ongoing use of eculizumab, presumably by terminal complement inhibition.Copyright © 2017 Asian Pacific Society of Nephrology |
| مصطلحات الفهرس: | drug dose reduction, drug substitution, drug withdrawal, end stage renal disease/su [Surgery], end stage renal disease/th [Therapy], fever/co [Complication], gastroscopy, graft versus host reaction/dt [Drug Therapy], graft versus host reaction/pc [Prevention], Haemophilus parainfluenzae, hemolysis/di [Diagnosis], hemolysis/si [Side Effect], HLA matching, human, hypercholesterolemia, hypertension, hypotension/co [Complication], hypotension/dt [Drug Therapy], immunosuppressive treatment, intensive care, kidney biopsy, kidney cortex necrosis/di [Diagnosis], kidney pancreas transplantation, leg thrombosis/di [Diagnosis], leg thrombosis/dt [Drug Therapy], leukocyte count, low drug dose, male, medical history, middle aged, pancytopenia/si [Side Effect], paronychia/co [Complication], paronychia/dt [Drug Therapy], peritoneal dialysis, plasma exchange, Pseudomonas infection/co [Complication], Pseudomonas infection/dt [Drug Therapy], reflux esophagitis/di [Diagnosis], remission, review, sigmoidoscopy, thrombocyte count, thrombosis/dt [Drug Therapy], thrombosis/pc [Prevention], thrombosis prevention, thrombotic thrombocytopenic purpura/co [Complication], thrombotic thrombocytopenic purpura/di [Diagnosis], thrombotic thrombocytopenic purpura/dt [Drug Therapy], thrombotic thrombocytopenic purpura/th [Therapy], triacylglycerol lipase blood level, urinary tract infection/co [Complication], urinary tract infection/dt [Drug Therapy], vomiting/si [Side Effect], acetylsalicylic acid/dt [Drug Therapy], basiliximab/cb [Drug Combination], basiliximab/dt [Drug Therapy], beta2 glycoprotein 1/ec [Endogenous Compound], cardiolipin antibody/ec [Endogenous Compound], corticosteroid/cb [Drug Combination], corticosteroid/dt [Drug Therapy], creatinine/ec [Endogenous Compound], eculizumab/ae [Adverse Drug Reaction], eculizumab/dt [Drug Therapy], eculizumab/iv [Intravenous Drug Administration], enoxaparin/dt [Drug Therapy], everolimus/dt [Drug Therapy], flucloxacillin/dt [Drug Therapy], flucloxacillin/iv [Intravenous Drug Administration], HLA antibody/ec [Endogenous Compound], inotropic agent/dt [Drug Therapy], leukocyte antigen/ec [Endogenous Compound], mycophenolic acid/cb [Drug Combination], mycophenolic acid/dt [Drug Therapy], novel erythropoiesis stimulating protein/dt [Drug Therapy], phospholipid antibody/ec [Endogenous Compound], piperacillin plus tazobactam/dt [Drug Therapy], prednisolone/dt [Drug Therapy], tacrolimus/cb [Drug Combination], tacrolimus/dt [Drug Therapy], thymocyte antibody/dt [Drug Therapy], triacylglycerol lipase/ec [Endogenous Compound], warfarin/dt [Drug Therapy], catheter/am [Adverse Device Effect], human tissue, adult, anemia/di [Diagnosis], anemia/dt [Drug Therapy], antibody titer, bacterium identification, biochemical analysis, bone marrow biopsy, bone marrow suppression/di [Diagnosis], case report, catheter, creatinine blood level, deep vein thrombosis/di [Diagnosis], deep vein thrombosis/dt [Drug Therapy], diabetic retinopathy, diarrhea/co [Complication], diarrhea/si [Side Effect], Doppler flowmetry, drug dose increase, Review |
| URL: | Nephrology Click here for full text options LibKey Link |
| الإتاحة: | Open access content. Open access content Copyright 2017 Elsevier B.V., All rights reserved. |
| أرقام أخرى: | AUSHL oai:repository.monashhealth.org:1/39529 Nephrology. 22 (Supplement 1) (pp 23-27), 2017. Date of Publication: 01 Feb 2017. 1320-5358 https://repository.monashhealth.org/monashhealthjspui/handle/1/39529Test Pathology Nephrology 28176480 [http://www.ncbi.nlm.nih.gov/pubmed/?term=28176480Test] 614367222 (Shochet, Kanellis, Mulley) Department of Nephrology, Monash Health, Melbourne, VIC, Australia (Simpson) Department of Anatomical Pathology, Monash Health, Melbourne, VIC, Australia (Kanellis, Mulley) Department of Medicine, Monash University, Melbourne, VIC, Australia (Ta) Australian Red Cross Blood Service, Melbourne, VIC, Australia Shochet L.; lani.shochet@gmail.com (Kanellis, Mulley) Department of Medicine, Monash University, Melbourne, VIC, Australia (Ta) Australian Red Cross Blood Service, Melbourne, VIC, Australia (Shochet, Kanellis, Mulley) Department of Nephrology, Monash Health, Melbourne, VIC, Australia (Simpson) Department of Anatomical Pathology, Monash Health, Melbourne, VIC, Australia 1305111906 |
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| رقم الانضمام: | edsoai.on1305111906 |
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