Thrombotic Microangiopathy Complicating Cyclosporine in Renal Transplant Patients

Abstract

Background and objectives: Experience with cyclosporine-associated thrombotic microangiopathy in renal allograft recipients is generally anecdotal; detailed descriptions of clinical behavior, therapeutic options and experience are also anecdotal and few. The aim of this study was to identify possible contributing factors to cyclosporine-associated thrombotic microangiopathy and to investigate therapeutic modifications that result in better graft survival in these patients. Methods: One thousand and twenty patients evaluated for this study received live-related or unrelated kidney transplants at Rizgary teaching hospital and Zheen international hospital between July 2011 and September 2016. The patients received standard induction therapy with anti-thymocyte globulin or basliximab and cyclosporine or mycophenplate and steroids. Regular follow-up with blood film and counts, reticulocyte count, liver enzymes, renal function tests, lactic dehydrogenas, haptoglobin and serum electrolytes were performed. Results: The prevalence of cyclosporine-associated thrombotic microangiopathy was 1.73%; of which 4(26.7%) were male while 11(73.3%) were female, with male to female ratio of 1:2.75. Mean age ±standard deviation of 36.87±10.927. Chronic glomerulonephritis was the most frequently distributed type of pre-transplant diagnosis 5 (33.3%), followed by focal segmental glomerulosclerosis 4 (26.7%) and diabetes mellitus 3 (20%). Live-related was the maximum frequent 10 (67%) while live unrelated is the minimum frequent 5 (33%). Conclusions: Thrombotic microangiopathy is a well-known complication of cyclosporine. Paying attention to signs of hemolysis and thrombocytopenia in the blood film are important clues in detecting early the diagnosis.