Transplant-associated Thrombotic Microangiopathy Treated with Eculizumab and Romiplostim
  • Muhammad Awidi
    Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
  • Meenu Jain
    Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
  • Russell Baur
    Lahey Hospital and Medical Center, Burlington, Massachusetts, USA

Keywords

Eculizumab, romiplostim, transplant thrombotic microangiopathy

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.

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References

  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Peffault de Latour R, Xhaard A, Fremeaux-Bacchi V, Coppo P, Fischer AM, Helley D, et al. Successful use of eculizumab in a patient with post-transplant thrombotic microangiopathy. Br J Haematol 2013;161(2):279–280.
  • Dhakal P, Giri S, Pathak R, Bhatt VR. Eculizumab in transplant-associated thrombotic microangiopathy. Clin Appl Thromb Hemost 2017;23(2):175–180.
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    Published: 2021-02-10
    Issue: 2021: Vol 8 No 2 (view)


    How to cite:
    1.
    Awidi M, Jain M, Baur R. Transplant-associated Thrombotic Microangiopathy Treated with Eculizumab and Romiplostim . EJCRIM 2021;8 doi:10.12890/2021_002294.