DRAFT - March 2011
Thrombotic microangiopathy (TMA) (or haemolytic uraemic syndrome, HUS) is an occasional post-transplant occurrence. When it occurs consider:
- Could HUS have been the primary diagnosis?
- Send complement level assays before plasma exchange
- Take DNA for complement genotyping
- Immunosuppression - difficult early post transplant, no calcineurin inhibitor is certain to be safe. Azathioprine, MMF can be regarded as safe, but position for ATG, OKT3 and sirolimus is uncertain too, these have also been implicated in causing small vessel thrombi.
- Consider eculizumab
- If live donor, consider high risk to the donor of developing the same problem
Alternative explanations for TMA might include antibody-mediated or vascular rejection, or possibly calcineurin inhibitor toxicity. Ischaemia/reperfusion may trigger TMA in susceptible individuals or be one of several 'hits' to the endothelium.
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