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An Atypical Presentation of Thrombotic Microangiopathy After Lung Transplant: a Case Report

2019Journal article Open access
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dc.contributor.authorMenezes, MM
dc.contributor.authorAires, I
dc.contributor.authorSemedo, L
dc.contributor.authorCalado, J
dc.contributor.authorRibeiro, F
dc.contributor.authorNolasco, F
dc.date.accessioned2021-10-08T14:21:28Z
dc.date.available2021-10-08T14:21:28Z
dc.date.issued2019
dc.description.abstractThrombotic microangiopathy (TMA) is a pathologic condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ injury due to microvascular endothelial lesions and thrombosis. It occurs in a variety of diseases and, unless recognized and treated, leads to severe morbidity and mortality. We present the case of a 48-year-old woman who underwent lung transplantation, initially under tacrolimus, mycophenolate mofetil (MMF), and prednisolone. Several complications emerged in the following months, including abdominal aortic and left renal artery thrombosis and cutaneous infections, although her renal function remained normal. Six months after transplant, her renal function began to deteriorate, which was assumed to be due to elevated tacrolimus levels and doses were adjusted. Due to leukopenia, MMF was changed to everolimus. One year after, she was admitted with fatigue, anemia, and renal dysfunction. Complementary exams revealed only iron deficiency, leukopenia, normal platelets, and elevated lactate dehydrogenase; her renal ultrasound was normal. A renal biopsy was performed and thrombotic microangiopathy was subsequently identified as the main cause of the renal dysfunction. Tacrolimus was therefore discontinued and MMF restarted with slow improvement of renal function. Only when everolimus was stopped did the patient's renal function show incremental improvement. TMA may be a serious complication after lung transplantation and the risk is higher when a combination of tacrolimus and everolimus is used. Renal biopsy findings are essential to confirm the final diagnosis of TMA, allowing for a change in immunosuppression to prevent permanent and severe renal damage.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationTransplant Proc. 2019 Jun;51(5):1633-1635.pt_PT
dc.identifier.doi10.1016/j.transproceed.2019.05.002.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3870
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectHCC NEFpt_PT
dc.subjectHSM PNEUpt_PT
dc.subjectFemalept_PT
dc.subjectHumanspt_PT
dc.subjectMiddle Agedpt_PT
dc.subjectEverolimus / therapeutic usept_PT
dc.subjectImmunocompromised Host*pt_PT
dc.subjectImmunosuppression / adverse effects*pt_PT
dc.subjectImmunosuppressive Agents / administration & dosagept_PT
dc.subjectImmunosuppressive Agents / adverse effectspt_PT
dc.subjectKidney Diseases / immunology*pt_PT
dc.subjectLung Transplantation* / adverse effectspt_PT
dc.subjectMycophenolic Acid / therapeutic usept_PT
dc.subjectTacrolimus / adverse effectspt_PT
dc.subjectThrombotic Microangiopathies / immunology*pt_PT
dc.titleAn Atypical Presentation of Thrombotic Microangiopathy After Lung Transplant: a Case Reportpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1635pt_PT
oaire.citation.startPage1633pt_PT
oaire.citation.titleTransplantation Proceedingspt_PT
oaire.citation.volume51pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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