Development of transplant renal artery thrombosis and signs of haemolytic-uraemic syndrome following the change from cyclosporin to tacrolimus in a renal transplant patient

The clinical presentation of post-transplantation thrombotic microangiopathy (TMA) is variable. Often, TMA will manifest systemically as haemolytic-uraemic syndrome (HUS), with classic findings of renal failure, haemolytic anaemia, schistocytes and thrombocytopenia [1]. Localized and systemic TMA represent a spectrum of severity of the same disorder, not two different disorders with distinct pathophysiological states. Pre-transplantation HUS, anticardiolipin antibodies, acute rejection, cytomegalovirus (CMV) and some medications are associated with the development of TMA. Herein we report a patient who developed the signs and symptoms of de novo HUS and transplant renal artery thrombosis following switching from cyclosporin to tacrolimus.