Thrombotic Microangiopathy Complicating Cyclosporine in Renal Transplant Patients

Safa  Al-Mukhtar

doi:10.56056/amj.2018.58

Authors

Safa Al-Mukhtar Department of Internal Medicine, Hawler College of Medicine, Erbil (Hawler), Kurdistan, Iraq

DOI:

https://doi.org/10.56056/amj.2018.58

Keywords:

Cyclosporine associated thrombotic microangiopathy, Focal segmental glomerulosclerosis, Hawler teaching hospital- Kidney disease center.

Abstract

Background and objectives: Experience with cyclosporine associated thrombotic microangiopathy in renal allograft recipients is generally anecdotal; detailed descriptions of clinical behavior, therapeutic options and experience are also anecdotal and few. The aim of this study was to identify possible contributing factors to cyclosporine associated thrombotic microangiopathy, and to investigate therapeutic modifications that result in better graft survival in these patients.

Methods:One thousand and twenty patientstients evaluated for this study received live related or unrelated kidney transplants at Rizgary teaching hospital and Zheen international hospital between July 2011 and September 2016. The patients received standard induction therapy with anti-thymocyte globulin or basliximab and cyclosporine or mycophenplate and steroids. Regular follow up with blood film and counts, reticulocyte count, liver enzymes, renal function tests, lactic dehydrogenas, haptoglobin and serum electrolytes were performed.

Results: The prevalence of cyclosporine associated thrombotic microangiopathy was 1.73%; of which 4(26.7%) were male while 11(73.3%) were female, with male to female ratio of 1:2.75. Mean age ±standard deviation of 36.87±10.927. Chronic glomerulonephritis was the most frequently distributed type of pre-transplant diagnosis 5 (33.3%), followed by focal segmental glomerulosclerosis 4 (26.7%) and diabetes mellitus 3 (20%). Live related was the maximum frequent 10 (67%) while live unrelated is the minimum frequent 5 (33%).

Conclusions: Thrombotic microangiopathy is a well- known complication of cyclosporine. Paying attention to signs of hemolysis and thrombocytopenia in the blood film are important clues in detecting early the diagnosis.

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