Tacrolimus-associated hemolytic uremic syndrome: a case analysis

J Nephrol. Jul-Aug 2003;16(4):580-5.

Abstract

Background: Tacrolimus is an effective organ transplantation immunosuppressant. Hemolytic uremic syndrome (HUS) is a rare but severe complication of tacrolimus.

Methods: We report a case of tacrolimus-associated HUS and review the 15 previously reported cases.

Results: The results of the 16 cases indicated that tacrolimus-associated HUS is more frequent in females (56.3%), with the mean age at onset of 41.3 years. Forty-four percent of cases received renal transplantations. The average time from the first tacrolimus dose to HUS onset was 7.1 months. Prevalence was between 0.14.7%. The tacrolimus trough level did not predict the prognosis. Seven patients (43.7%) had improved graft function after treatment, including anticoagulation and antiplatelet therapy, reduction or discontinuation of tacrolimus, switch to cyclosporine (CyA), plasma exchange (PE) and dialysis. Five patients (31.3%) died and four patients (25%) lost their graft in spite of the above treatment. Mortality risk factors for transplant recipients with tacrolimus-associated HUS included: (1) non-renal transplant recipients (100% vs. 36.4%, p = 0.034); (2) lower peak serum Cr (2.58 +/- 1.23 vs. 6.16 +/- 1.96, p < 0.002); (3) liver dysfunction (60% vs. 0, p < 0.02); (4) higher serum lactate dehydrogenase (LDH) level (3119 +/- 1019 vs. 982 +/- 522, p < 0.001). A lower platelet count carried borderline mortality risk (29500 +/- 14480 vs. 59625 +/- 25584, p = 0.057).

Conclusions: HUS should be included in the differential diagnosis of renal function deterioration in patients on tacrolimus post-organ transplantation. Frequent renal function monitoring and appropriate treatment should be performed aggressively to decrease morbidity and mortality, especially in patients with risk factors.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Biopsy, Needle
  • Follow-Up Studies
  • Graft Rejection
  • Hemolytic-Uremic Syndrome / chemically induced*
  • Hemolytic-Uremic Syndrome / pathology*
  • Hemolytic-Uremic Syndrome / therapy
  • Humans
  • Immunohistochemistry
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / methods
  • Male
  • Peritoneal Dialysis, Continuous Ambulatory / methods
  • Postoperative Complications / drug therapy
  • Reoperation
  • Risk Assessment
  • Severity of Illness Index
  • Staphylococcal Infections / drug therapy*
  • Tacrolimus / adverse effects*
  • Tacrolimus / therapeutic use
  • Treatment Outcome

Substances

  • Tacrolimus