{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,15]],"date-time":"2024-09-15T21:57:13Z","timestamp":1726437433713},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2007,1,2]],"date-time":"2007-01-02T00:00:00Z","timestamp":1167696000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2007,3]]},"abstract":"<jats:p><jats:bold>Abstract:\u2002<\/jats:bold> Thrombotic microangiopathy (TMA) is rare after transplantation and is associated with a high incidence of kidney graft dysfunction. Between December 2000 and March 2006, 136 simultaneous pancreas\u2013kidney transplantations were performed with an incidence of TMA of 5.1% (71.4% localized to kidney allograft). All cases were diagnosed during the first three months and were attributed to tacrolimus; 74% were women. Systemic TMA presented higher values of lactate dehydrogenase (2658\u2003\u00b1\u2003659\u2003U\/L vs. 1331\u2003\u00b1\u2003473\u2003U\/L, p\u2003=\u20030.04) and a greater decrease in hematocrit (45.8\u2003\u00b1\u200317.7% vs. 19.2\u2003\u00b1\u20036%, p\u2003=\u20030.02) than in localized TMA. Acute kidney rejection complicated almost 90% of the cases with 43% of kidney graft lost. Tacrolimus was switched to sirolimus and fresh\u2010frozen plasma was administered. Creatinine clearance after a mean follow\u2010up of two yr was 100.7\u2003mL\/min\/1.73\u2003m<jats:sup>2<\/jats:sup> and 57.9\u2003mL\/min\/1.73\u2003m<jats:sup>2<\/jats:sup> in patients with systemic and localized TMA, respectively. In conclusion, sirolimus is an alternative to TMA associated with tacrolimus.<\/jats:p>","DOI":"10.1111\/j.1399-0012.2006.00633.x","type":"journal-article","created":{"date-parts":[[2007,1,2]],"date-time":"2007-01-02T18:33:01Z","timestamp":1167762781000},"page":"241-245","source":"Crossref","is-referenced-by-count":5,"title":["Thrombotic microangiopathy after simultaneous pancreas\u2013kidney transplantation"],"prefix":"10.1111","volume":"21","author":[{"given":"\u00c9rika B.","family":"Rangel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriano M.","family":"Gonzalez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcelo M.","family":"Linhares","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00e9rgio 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