Thrombotic microangiopathy caused by oral contraceptives in a kidney transplant recipient

• Published in: Nephrology (Carlton, Vic.) Vol. 21; no. S1; pp. 41 - 43
• Main Authors: Shirai, Hiroyuki, Yashima, Jun, Tojimbara, Tamotsu, Honda, Kazuho
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-07-2016
• Subjects: ABO Blood-Group System - immunology; Adult; Allografts; Biopsy; Blood Group Incompatibility - immunology; Contraceptives, Oral, Hormonal - adverse effects; Ethinyl Estradiol-Norgestrel Combination - adverse effects; Female; graft loss; Histocompatibility; Humans; kidney; Kidney - drug effects; Kidney - immunology; Kidney - pathology; Kidney - physiopathology; Kidney Transplantation - adverse effects; Living Donors; oral contraceptives; Risk Factors; Thrombotic Microangiopathies - chemically induced; Thrombotic Microangiopathies - diagnosis; Thrombotic Microangiopathies - immunology; Thrombotic Microangiopathies - physiopathology; thrombotic microangiopathy; Time Factors; transplantation; Treatment Outcome; kidney; oral contraceptives; thrombotic microangiopathy; graft loss; transplantation
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.12769

Thrombotic microangiopathy (TMA) after kidney transplantation has various aetiologies, including acute antibody‐mediated rejection, bacterial or viral infection and immunosuppressive drugs, particularly calcineurin inhibitors. We present the case of a 28‐year‐old woman who developed TMA 30 months after the transplantation of an ABO‐incompatible kidney from a living unrelated donor. The patient developed a sudden onset of allograft renal dysfunction and became uremic. She was transferred to our institution from a community hospital with strongly suspected acute allograft rejection. Intensive treatments for both T‐ and B‐cell mediated acute rejection, including steroid pulse therapy, double‐filtration plasmapheresis, antithymocyte globulin (1.5 mg/kg × 14 days) and rituximab (100 mg), were initiated during haemodialysis. However, her renal allograft function did not improve. Histopathological analysis 8 days after the treatment indicated TMA, despite the absence of apparent acute T‐cell‐ or acute antibody‐mediated rejection. There were no symptoms of infectious diseases, such as intestinal haemorrhagic colitis or viral infection. We concluded that the use of oral contraceptives, which had been initiated 3 weeks before TMA onset for the treatment of irregular vaginal bleeding, was the aetiologic agent.