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. 2021 Feb 10;8(3):002294.
doi: 10.12890/2021_002294. eCollection 2021.

Transplant-associated Thrombotic Microangiopathy Treated with Eculizumab and Romiplostim

Muhammad Awidi  1 , Meenu Jain  1 , Russell Baur  1
Affiliations

Transplant-associated Thrombotic Microangiopathy Treated with Eculizumab and Romiplostim

Muhammad Awidi et al. Eur J Case Rep Intern Med. .

Abstract

Transplant-associated thrombotic microangiopathy (TA-TMA) can occur after solid organ transplantation. It results in thrombocytopenia, haemolytic anaemia and microvascular occlusion. TA-TMA is not fully understood and treatment has not been clearly established. However, there is increasing evidence to suggest an immune-complement mediated component to its development. Eculizumab is a monoclonal antibody that inhibits the cleavage of C5 into pro-inflammatory, prothrombotic terminal complement elements and has been utilized in the treatment of atypical haemolytic uremic syndrome. We report a case of TA-TMA successfully treated with eculizumab and romiplostim. This case adds to the evidence that TA-TMA is triggered by complement dysregulation and suggests possible interventions for refractory cases.

Learning points: Transplant-associated thrombotic microangiopathy (TA-TMA) may occur in solid organ transplant patients.Eculizumab may be used for the treatment of TA-TMA.

Keywords: Eculizumab; romiplostim; transplant thrombotic microangiopathy.

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Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

References

    1. Nwaba A, MacQuillan G, Adams LA, Garas G, Delriviere L, Augustson B, et al. Tacrolimus-induced thrombotic microangiopathy in orthotopic liver transplant patients: case series of four patients. Intern Med J. 2013;43(3):328–333. - PubMed
    1. Chapin J, Shore T, Forsberg P, Desman G, Van Besien K, Laurence J. Hematopoietic transplant-associated thrombotic microangiopathy: case report and review of diagnosis and treatments. Clin Adv Hematol Oncol. 2014;12(9):565–573. - PubMed
    1. Tamura S, Sugawara Y, Matsui Y, Kishi Y, Akamatsu N, Kaneko J, et al. Thrombotic microangiopathy in living-donor liver transplantation. Transplantation. 2005;80(2):169–175. - PubMed
    1. Wijnsma KL, Ter Heine R, Moes D, Langemeijer S, Schols SEM, Volokhina EB, et al. Pharmacology, pharmacokinetics and pharmacodynamics of eculizumab, and possibilities for an individualized approach to eculizumab. Clin Pharmacokinet. 2019;58(7):859–874. - PMC - PubMed
    1. Okano M, Sakata N, Ueda S, Takemura T. Recovery from life-threatening transplantation-associated thrombotic microangiopathy using eculizumab in a patient with very severe aplastic anemia. Bone Marrow Transplant. 2014;49(8):1116–1118. - PubMed

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