Calcineurin Inhibitor-Free Immunosuppression in Renal Allograft Recipients with Thrombotic Microangiopathy/Hemolytic Uremic Syndrome
Article first published online: 19 JAN 2006
American Journal of Transplantation
Volume 6, Issue 2, pages 412–418, February 2006
How to Cite
Øyen, O., Strøm, E. H., Midtvedt, K., Bentdal, Ø., Hartmann, A., Bergan, S., Pfeffer, P. and Brekke, I. B. (2006), Calcineurin Inhibitor-Free Immunosuppression in Renal Allograft Recipients with Thrombotic Microangiopathy/Hemolytic Uremic Syndrome. American Journal of Transplantation, 6: 412–418. doi: 10.1111/j.1600-6143.2005.01184.x
- Issue published online: 19 JAN 2006
- Article first published online: 19 JAN 2006
- Received 13 July 2005, revised 11 October 2005 and accepted for publication 13 October 2005.
- Hemolytic-uremic syndrome;
- renal transplantation;
- thrombotic microangiopathy;
- thrombotic thrombocytopenic purpura
Thrombotic microangiopathy (TMA) and hemolytic uremic syndrome (HUS) represent serious threats to kidney allograft recipients.
During a 4-year period, among 850 kidney transplantations, seven recipients with primary HUS and seven recipients (eight transplants) with previous or de novo TMA/HUS were identified and given calcineurin inhibitor (CNI)-free immunosuppression by sirolimus (SRL), mycophenolate mofetil and steroids.
Thirteen out of 15 transplantations were successful in the long term; resulting in a mean creatinine of 101 μmol/L (16.4 months follow-up). In patients maintained on CNI-free regimen, no TMA/HUS recurrences were observed. A high rate of acute rejections (53%) may indicate insufficient immunosuppressive power and/or a causative relationship between TMA/HUS and rejection. Wound-related complications were abundant (60%), and call for surgical/immunosuppressive countermeasures.
Our experience supports the idea that CNI's are major offenders in TMA/HUS induction. Total CNI elimination seems essential, as the nephrotoxic combination CNI + SRL may promote TMA. Features of TMA/HUS should be carefully explored in recurrent 'high responders'.