Clopidogrel-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in a kidney/pancreas transplant recipient

Background. We present a case report of thrombotic thrombocytopenic purpura /hemolytic uremic syndrome (TTP/HUS) developing in a kidney/pancreas transp lant recipient after the initiation of treatment with clopidogrel for sympt omatic coronary artery disease. Methods. A 35-year-old male kidney/pancreas recipient developed unstable an gina 5 years after transplantation. The patient was treated with clopidogre l as adjunct therapy. A TTP/HUS condition developed, was diagnosed early, a nd successfully reversed with the implementation of plasmapheresis and cess ation of clopidogrel and cyclosporine A. Results. The patient continues taking cyclosporine A with good renal functi on 6 months after the incident, and successfully underwent coronary artery by pass grafting 3 months after the event. Discussion. This case demonstrates that early identification and treatment can reverse the TTP/HUS process associated with thienopyridine derived agen ts. We strongly recommend that drugs of the thienopyridine class be used ca utiously in transplant recipients, especially those taking calcineurin-inhi bitors.