Eculizumab therapy in gemcitabine-induced thrombotic microangiopathy in a renal transplant recipient.

2019-06

Martin, Kylie

Roberts, Veena

Chong, Geoffrey

Goodman, David

Hill, Prue

Ierino, Francesco

Journal Article

10.1093/omcr/omz048

A renal transplant recipient 7 years post-transplantation, diagnosed with locally advanced pancreatic adenocarcinoma developed thrombotic microangiopathy (TMA) after treatment with gemcitabine and nab-paclitaxel. Gemcitabine was the most likely cause for TMA and was ceased. He received methylprednisolone and plasma exchange with fresh frozen plasma and albumin. Despite plasma exchange, his renal allograft function worsened, and he had persistent haematological evidence of haemolysis. Eculizumab was commenced with resolution-significant improvement in his renal and haematological markers. This case highlights an unusual occurrence of progressive gemcitabine-induced TMA in a renal allograft that had an excellent response to eculizumab. The clinical response also demonstrates involvement of complement dysregulation in gemcitabine-induced TNA.

link

Oxford medical case reports 2019; 2019(6): omz048

Oxford medical case reports

2053-8855