Sirolimus rescue for tacrolimus‐associated post‐transplant autoimmune hemolytic anemia

Valentini, Rudolph P.; Imam, Abubakr; Warrier, Indira; Ellis, Demetrius; Ritchey, A. Kim; Ravindranath, Yaddanapudi; Shapiro, Ron; Moritz, Michael L.

doi:10.1111/j.1399-3046.2005.00460.x

Cited by 35 publications

(26 citation statements)

References 18 publications

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“…Reduction of the dose of immunosuppressive therapy led to improvement of AIHA and PRCA. AIHA may also occur after renal transplantation [75], cardiac transplantation [76], and liver transplantation [77].…”

Section: Aiha After Transplantation Of Solid Organsmentioning

confidence: 99%

Diagnosis and treatment of autoimmune haemolytic anaemias in adults: a clinical review

Valent

Lechner

2008

Wien Klin Wochenschr

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Autoimmune haemolytic anaemia (AIHA) is an immune disorder caused by antibodies directed against unmodified autologous red cells. The disorder may be a primary (idiopathic) or a secondary disease. The diagnosis is based on the presence of anaemia, signs of haemolysis with reticulocytosis, low haptoglobin, increased lactate dehydrogenase, elevated indirect bilirubin, and a positive direct antiglobulin test (Coombs test). Sometimes, not all of these typical features are present. Most AIHA are caused by warm antibodies, whereas cold antibodies are less commonly detected. While half of the warm antibody-based AIHA are idiopathic anaemias, almost all cold antibody AIHA are secondary anaemias. Underlying diseases are Non Hodgkin's lymphomas and systemic autoimmune disorders, and less frequently organ transplantation, infections, or solid tumors. Moreover, AIHA is an important complication of treatment with nucleoside analogs. Most patients with AIHA require therapy. In warm antibody AIHA, standard first line therapy are glucocorticosteroids with or without high dose immunoglobulins, whereas splenectomy is considered second-line therapy. Response rates of primary AIHA to corticosteroid therapy are high. After initial remission, the dose should be tapered down slowly and with caution, and in some cases, low-dose maintenance therapy is required. The efficacy of standard therapy is low in secondary AIHA that develops in lymphoma patients, posttransplant patients, or tumor patients. Among other immunosuppressive treatments, rituximab (anti-CD20) appears to be highly effective in patients with warm antibody AIHA refractory to standard therapy. Mycophenolate mofetil is quite effective in AIHA patients with an underlying autoimmune or lymphoproliferative disease. Patients with cold agglutinins are refractory to steroids and splenectomy. Half of these patients may respond to rituximab, although responses usually are short-lived. Sometimes, AIHA that is associated with malignant lymphomas or tumors, disappears after successful anti-lymphoma or anti-tumor therapy.

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Section: Aiha After Transplantation Of Solid Organsmentioning

confidence: 99%

Diagnosis and treatment of autoimmune haemolytic anaemias in adults: a clinical review

Valent

Lechner

2008

Wien Klin Wochenschr

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“…On the basis of the importance of T-cell immunity for proper B-cell regulation, we must consider the immunosuppressive regimen of a transplant recipient with AIHA [24,25] and sirolimus could be an alternative immunosuppressive agent in resistant patients.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune cytopaenia after paediatric intestinal transplantation: a case series

Arcos¹,

Ybarra²,

Ramos³

et al. 2010

Transplant International

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“…Tacrolimus in particular has been associated with AIHA in liver transplant recipients [56]. Often, the toxicity associated with calcineurin inhibitors is dose dependent and may resolve by decreasing the drug dose, or switching to another drug [57].…”

Section: Haematological Complicationsmentioning

confidence: 99%

Liver transplantation in children

Muiesan

Vergani

Mieli‐Vergani

2007

Journal of Hepatology

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Sirolimus rescue for tacrolimus‐associated post‐transplant autoimmune hemolytic anemia

Cited by 35 publications

References 18 publications

Diagnosis and treatment of autoimmune haemolytic anaemias in adults: a clinical review

Diagnosis and treatment of autoimmune haemolytic anaemias in adults: a clinical review

Autoimmune cytopaenia after paediatric intestinal transplantation: a case series

Liver transplantation in children

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