Thrombotic microangiopathy after liver small bowel transplant

We herein report the first case of immunosuppression-associated thrombotic microangiopathy (TMA) in which an extrarenal graft was primarily affected b y the characteristic microvascular lesions. Although TMA is a well-known co mplication of cyclosporine (CSA) or tacrolimus therapy in renal and extrare nal (liver, heart, lung) transplant recipients, the kidney (transplanted or native) is typically the site primarily affected. We describe a combined l iver-small bower transplant recipient who developed tacrolimus-associated T MA that affected both her transplanted small bowel and her native kidneys. Involvement of the bower, with evidence of microvascular occlusion on biops y, led to the development of ischemic mucosal ulcers and eventual bowel per foration. Involvement of the kidney manifested with a doubling of the recip ient's baseline serum creatinine level. Significant lowering of the tacroli mus dose resulted in healing of the small bowel ulcers and return to her ba seline revel of renal function. Therefore, it is important to note that, in transplant recipients, TMA with microvascular occlusion may affect extrare nal sites. In small bower transplant recipients, the result might be ischem ic ulcers in the graft and eventual bowel perforation.