Treatment with sirolimus ameliorates tacrolimus-induced autoimmune cytopenias after solid organ transplant.

Abstract

The development of autoimmune blood cell cytopenias is a potentially life-threatening complication of solid organ transplantation, resulting from T-cell dysregulation from immunosuppressive medications. Conventional treatment with corticosteroids and IVIgG is often unsuccessful as these therapies are unlikely to overcome the T-cell dysregulation. We describe two patients who developed severe autoimmune cytopenias after solid organ transplantation. They had limited response to conventional medications, but had complete resolution of autoimmunity upon transition of immunosuppression from tacrolimus to sirolimus. Altering the immunosuppressive regimen to modify T-cell dysregulation may be beneficial for patients who develop post-transplant autoimmune disease and allow continued preservation of allograft.

• Authors: David T Teachey, Tracey Jubelirer, H Jorge Baluarte, Amanda Wade, Catherine S Manno
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 53 Issue 6 Pg. 1114-6 (Dec 2009) ISSN: 1545-5017 [Electronic] United States
• PMID: 19621445 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Immunosuppressive Agents
• Sirolimus
• Tacrolimus

Topics

• Adolescent
• Autoimmune Diseases (chemically induced)
• Heart Transplantation
• Humans
• Immunosuppressive Agents (therapeutic use)
• Liver Transplantation
• Male
• Organ Transplantation (adverse effects)
• Pancytopenia (chemically induced, immunology)
• Sirolimus (therapeutic use)
• Tacrolimus (adverse effects)