Cyclosporine-associated thrombotic microangiopathy during daclizumab induction: a suggested therapeutic approach
| Autor: | Emilio Freixas, O. Rabinovich, J. Schropp, H. Pereyra, Hernán Trimarchi, E. Bullorsky |
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| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty Thrombotic microangiopathy Daclizumab medicine.medical_treatment Urology Blood Component Transfusion Antibodies Monoclonal Humanized Hemolysis Tacrolimus Fibrin Fibrinogen Degradation Products medicine Living Donors Humans Kidney transplantation Polycystic Kidney Diseases business.industry Microcirculation Panel reactive antibody Antibodies Monoclonal Thrombosis Plasmapheresis Middle Aged medicine.disease Ciclosporin Kidney Transplantation eye diseases Surgery Discontinuation Immunoglobulin G Cyclosporine Kidney Failure Chronic Drug Therapy Combination Female business Biomarkers Immunosuppressive Agents medicine.drug |
| Zdroj: | Nephron. 87(4) |
| ISSN: | 1660-8151 |
| Popis: | A woman on daclizumab developed thrombotic microangiopathy secondary to cyclosporine after a living-unrelated kidney transplant. Despite cyclosporine discontinuation, hemolysis persisted. The second dose of daclizumab was postponed 24 h, and after a maximum of two sessions of plasmapheresis (to avoid further modifications in daclizumab schedule) with plasma exchange, daclizumab was administered. Plasma infusions were prescribed until D-dimer and fibrinogen-degradation products normalized; thereafter, FK-506 was started without recurrence of the hemolytic picture and renal function restored. This observation suggests that in patients on daclizumab who develop thrombotic microangiopathy secondary to immunosuppressants, if discontinuation of the offending drug is unsuccessful, plasmapheresis with plasma exchange can be performed when the lowest levels of daclizumab exist, followed by daclizumab infusion. Plasma prescription must be continued thereafter until D-dimer and figrinogen-degradation products normalize. However, if hemolysis persists when daclizumab levels are high, plasma infusions are useful and plasmapheresis avoided. FK-506 administration did not result in recurrence of hemolysis during daclizumab induction. |
| Databáze: | OpenAIRE |
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