Cyclosporine and tacrolimus–associated thrombotic microangiopathy

Intestinal thrombotic microangiopathy following reduced-intensity umbilical cord blood transplantation

“…2,12 There is little information on the pathogenesis of intestinal TMA following RI-CBT. TMA after myeloablative HSCT has a multifactorial etiology that includes immunosuppressive agents, 14,15 total body irradiation (TBI), 16 CMV infection, 17 and acute GVHD. 18 These factors injure the vascular endothelium of many organs.…”

Transplantation-associated thrombotic microangiopathy: twenty-two years later

“…13,14 Recent reports have also documented the occurrence of TA-TMA in solid organ and bone marrow transplant recipients receiving immunosuppression with tacrolimus. 15 Two recent case-control studies have examined risk factors for TA-TMA in allogeneic bone marrow transplant recipients in more detail. Fuge et al 7 examined 22 cases of TA-TMA occurring over a 6-year period among patients admitted to a combined pediatric and adult bone marrow transplant unit.…”

“…Mycophenolate mofetil, azathioprine and anti-T cell antibody therapies have been reported as appropriate alternatives, although the use of these agents may be associated with dose limiting myelosuppression in bone marrow transplant recipients. 15,39 In addition, mycophenolate mofetil and azathioprine may be associated with a delayed onset of action, necessitating the addition of increased doses of corticosteroids in cases in which TA-TMA occurs on a background of GVHD.…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…De novo HUS/TTP can occur after exposure to CsA, and in this setting replacing CsA with tacrolimus has been reported to be beneficial in some cases (343,347,348) but not in others (349). Certainly de novo HUS/TTP can also occur in patients being treated with tacrolimus (343,350,351), and there is no evidence that the incidence of HUS/TTP is different for CsA compared to tacrolimus (352).…”