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      Eculizumab therapy in gemcitabine-induced thrombotic microangiopathy in a renal transplant recipient.

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          Abstract

          A renal transplant recipient 7 years post-transplantation, diagnosed with locally advanced pancreatic adenocarcinoma developed thrombotic microangiopathy (TMA) after treatment with gemcitabine and nab-paclitaxel. Gemcitabine was the most likely cause for TMA and was ceased. He received methylprednisolone and plasma exchange with fresh frozen plasma and albumin. Despite plasma exchange, his renal allograft function worsened, and he had persistent haematological evidence of haemolysis. Eculizumab was commenced with resolution-significant improvement in his renal and haematological markers. This case highlights an unusual occurrence of progressive gemcitabine-induced TMA in a renal allograft that had an excellent response to eculizumab. The clinical response also demonstrates involvement of complement dysregulation in gemcitabine-induced TNA.

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          Author and article information

          Journal
          Oxf Med Case Reports
          Oxford medical case reports
          Oxford University Press (OUP)
          2053-8855
          2053-8855
          Jun 2019
          : 2019
          : 6
          Affiliations
          [1 ] Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy 3065 Victoria, Australia.
          [2 ] Olivia-Newton John Cancer, Wellness and Research Centre, Austin Hospital, Heidelberg, Australia.
          Article
          omz048
          10.1093/omcr/omz048
          6568204
          31214360

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