SHM Converge Scientific Abstract ePoster Gallery-Early Donor Derived Thrombotic Thrombocytopenic Purpura Secondary to Kidney Transplant

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A 53-year-old man with a complex autoimmune history, including Goodpasture syndrome, systemic lupus erythematosus, and Wegener’s granulomatosis, underwent a deceased-donor kidney transplant for end-stage renal disease. Within two days after surgery, he developed anemia, thrombocytopenia, elevated lactate dehydrogenase, and worsening creatinine, raising concern for thrombotic thrombocytopenic purpura (TTP). Tacrolimus was stopped due to possible drug-induced thrombotic microangiopathy, and plasmapheresis was started along with hemodialysis.<br /><br />Although LDH improved and platelet counts stabilized after plasma exchange, kidney function remained poor. Imaging showed absent blood flow to part of the transplanted kidney, and biopsy revealed extensive ischemic necrosis with arterial and capillary thrombi. ADAMTS13 levels were unmeasurable, supporting a diagnosis of TTP/microangiopathic process. Because of poor graft perfusion, the patient ultimately underwent nephrectomy, after which his overall condition improved.<br /><br />The case highlights a rare but serious complication after kidney transplantation. TTP is caused by severe ADAMTS13 deficiency, leading to accumulation of large von Willebrand factor multimers and formation of microthrombi. In transplant patients, TTP or transplant-associated thrombotic microangiopathy can be triggered by medications such as tacrolimus or may, in rare cases, be donor-derived. Diagnosis relies on laboratory findings such as thrombocytopenia, hemolytic anemia, elevated LDH, low haptoglobin, and schistocytes. Early plasma exchange is the recommended first-line treatment, but post-transplant TMA is associated with poor graft survival and significant mortality.

Asset Subtitle

Vinay Kumar Gadamidi

Meta Tag

Author List Mark Sunga, Tehmina Habib, Vikram Bathula, Vinay Kumar Gadamidi

Category Clinical Vignettes

Concept Thrombotic Thrombocytopenic Purpura

Concept Anemia

Concept Thrombocytopenia

Concept ADAMTS13

Concept Tacrolimus

Distinguished Non-Finalist

Presenter Organization Virtua Health

Presenting Author Vinay Kumar Gadamidi

Track Adult

Keywords

kidney transplant

thrombotic thrombocytopenic purpura

ADAMTS13 deficiency

tacrolimus

thrombotic microangiopathy

plasmapheresis

hemolytic anemia

thrombocytopenia

renal graft failure

microthrombi

Thrombotic Thrombocytopenic Purpura

Anemia

Thrombocytopenia

ADAMTS13

Tacrolimus