Thrombotic Microangiopathy Post-Transplant

Primary Immunosuppressive Agents

The American Society of Nephrology recommends that calcineurin inhibitors, such as cyclosporine and tacrolimus, be used with caution in transplant patients due to their association with thrombotic microangiopathy through endothelial injury and microangiopathy 1, 2, 3, 4
The National Kidney Foundation notes that both cyclosporine and tacrolimus can cause TMA through microangiopathy and hemolysis as their most common mechanism of anemia post-transplant 1, 2, 3, 4
Sirolimus is associated with thrombotic microangiopathy both as monotherapy and in combination with CNIs, according to the American Society of Transplantation 1, 2, 3, 4
OKT3 (muromonab-CD3) has been associated with hemolytic uremic syndrome and microangiopathy, as reported by the American College of Physicians 1, 2, 3, 4

The International Society of Nephrology recommends that hypertension, thrombocytopenia, and elevated LDH should prompt immediate suspicion of TMA in any transplant patient on calcineurin inhibitors 5
Severe vascular rejection episodes can trigger TMA as an additional mechanism, according to the American Society of Nephrology 1, 2, 3, 4