{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T18:05:52Z","timestamp":1773252352997,"version":"3.50.1"},"reference-count":16,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2017,2,7]],"date-time":"2017-02-07T00:00:00Z","timestamp":1486425600000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nephrology"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Thrombotic microangiopathy (TMA) is a well\u2010recognised complication following transplantation, often due to an underlying genetic predisposition, medications or rejection. The use of eculizumab in these settings has been previously described, but its role still remains to be clarified.<\/jats:p><jats:p>A 45\u2010year\u2010old man, with a history of type 1 diabetes mellitus and subsequent end\u2010stage kidney failure, presented for a simultaneous pancreas\u2010kidney transplant. Immunologically, he was well matched with the donor, and he received standard induction immunosuppression including tacrolimus. His early transplant course was complicated by Haemophilus parainfluenzae paronychia and a Pseudomonas aeruginosa catheter\u2010associated urinary tract infection. Within 1 week, he developed thrombotic microangiopathy with significant renal dysfunction and eventual dialysis dependence, without evidence of transplant rejection on biopsy. He was also noted to have antiphospholipid antibodies in moderate titres. The TMA did not resolve despite cessation of tacrolimus, and he was subsequently commenced on eculizumab. The patient achieved a partial remission from TMA, with ongoing biochemical evidence of haemolysis, although now with stable graft function, despite significant damage. His transplanted pancreas remained seemingly unaffected by TMA, and continues to function well.<\/jats:p><jats:p>This case describes an unusual presentation of TMA post\u2010transplantation and is the only described case of eculizumab use following pancreas\u2010kidney transplant. It remains unclear in this case what the likely precipitant for TMA was, although it seems to be, at least in part, controlled by ongoing use of eculizumab, presumably by terminal complement inhibition.<\/jats:p>","DOI":"10.1111\/nep.12936","type":"journal-article","created":{"date-parts":[[2017,2,8]],"date-time":"2017-02-08T04:56:29Z","timestamp":1486529789000},"page":"23-27","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["De novo thrombotic microangiopathy following simultaneous pancreas and kidney transplantation managed with eculizumab"],"prefix":"10.1111","volume":"22","author":[{"given":"Lani","family":"Shochet","sequence":"first","affiliation":[{"name":"Department of Nephrology Monash Health  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Kanellis","sequence":"additional","affiliation":[{"name":"Department of Nephrology Monash Health  Melbourne Victoria Australia"},{"name":"Department of Medicine Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Simpson","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology Monash Health  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Ta","sequence":"additional","affiliation":[{"name":"Australian Red Cross Blood Service  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Mulley","sequence":"additional","affiliation":[{"name":"Department of Nephrology Monash Health  Melbourne Victoria Australia"},{"name":"Department of Medicine Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,2,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2006.01753.x"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1432-2277.2006.00354.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.1093\/oxfordjournals.ndt.a027673","article-title":"Renal transplantation in adults with thrombotic thrombocytopaenic purpura\/haemolytic\u2010uraemic syndrome","volume":"11","author":"Brennan DC","year":"1996","journal-title":"Nephrology, Dialysis, Transplantation"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajkd.2003.07.008"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc0808527"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2012.04252.x"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trre.2013.07.003"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.4103\/0971-4065.125052"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2005.00438.x"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2005.02.112"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/nep.12768"},{"issue":"21","key":"e_1_2_6_13_1","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1182\/blood.V122.21.1078.1078","article-title":"Successful management of calcineurin induced thrombotic microangiopathy (TMA) with eculizumab after non\u2010 renal solid organ transplantation. 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