Tacrolimus-induced hemolytic uremic syndrome and end-stage renal failure after liver transplantation

Background. Hemolytic uremic syndrome (HUS) is a rare complication in solid organ transplantation. It can be associated with severe hypertension. Seve ral risk factors have been identified including immunosuppressive drugs suc h as cyclosporin A and, more recently, tacrolimus. Methods. Here we report a case of tacrolimus-induced HUS in a 61-yr-old wom an after liver transplantation. Hypertension, microangiopathic anemia and e nd-stage renal failure occurred 2 yr after liver transplantation. Results. At admission, she had malignant hypertension with a severe hyperte nsive retinopathy, renal failure (creatininemia: 800 mu mol/L) and microang iopathic anemia (Hb: 7.3 g/dL, a low platelet count and elevated lactate de hydrogenase). At renal biopsy, histologic findings were ischemic and sclero tic glomeruli with hyaline thrombi, severe mesangiolysis and interstitial f ibrosis. Conclusion. Despite steroid treatment, antihypertensive agents and fresh fr ozen plasma therapy, end-stage renal failure was observed and chronic hemod ialysis treatment was required.