CYCLOSPORINE-ASSOCIATED THROMBOTIC MICROANGIOPATHY HEMOLYTIC UREMIC SYNDROME FOLLOWING KIDNEY AND KIDNEY-PANCREAS TRANSPLANTATION/

Cyclosporine-associated thrombotic microangiopathy (CsA-TMA) is charac terized by anemia, acute renal failure, and renal TMA. We report a cas e-control study of 13 patients (seven kidney-alone transplant recipien ts and six kidney-pancreas transplant recipients) who developed TMA (1 2 CsA, 1 FK506). Once CsA-TMA was identified, CsA or FK506 was discont inued and isradipine, aspirin, and pentoxifylline were started. Cyclos porine was reinstituted in all patients once serum creatinine reached the previous baseline value. Patients developing further decreases in renal function on rechallenge with CsA were converted to FK506 (n = 3) . Rechallenge with CsA was successful in nine of the 13 patients (69%) , with three (23%) converted to FK506 for a total salvage rate of 92%. The creatinine clearance at 6 months, 1 year, and 2 years following t ransplantation was 73.2 +/- 25.7 mL/min, 54.7 +/- 18.8 mL/min, and 57. 0 +/- 32.0 mL/min, respectively, for patients successfully rechallenge d with CsA compared with 67 +/- 17 mg/min, 71.8 +/- 21.2 mL/min, and 6 9 +/- 19 mg/min, respectively, for controls (P = NS). The average crea tine clearance for patients converted to FK506 was 44.7 +/- 31.2 mL/mi n at 6 months following transplantation (n = 3) and 27.0 +/- 11.3 mL/m in at 1 year. In this case-controlled retrospective series of renal tr ansplant patients with documented CsA-TMA, the triple-drug combination of isradipine, aspirin, and pentoxifylline allowed for the successful reinstitution of CsA or conversion to FK506 in the setting of TMA, an d resulted in increased transplant survival compared with previous rep orts. (C) 1996 by the National Kidney Foundation, Inc.