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Basiliximab for early perioperative transplant-associated thrombotic microangiopathy after lung transplantation: a
Naohiro Ijiri1, Masaaki Sato2, Chihiro Konoeda1
1Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
Background:
Thrombotic microangiopathy is a syndrome characterized by microangiopathic hemolytic anemia and platelet aggregation, which is caused by endothelial injury, microcirculation thrombosis, and fibrin deposition. Transplant-associated thrombotic microangiopathy rarely occurs after lung transplantation and the onset is generally later than that after bone marrow or other solid organ transplantation. The treatment is to stop administration of the causal agent, which is often a calcineurin inhibitor, such as tacrolimus and cyclosporine. We herein report the case of a patient with early post-transplant thrombotic microangiopathy after lung transplantation treated by introducing basiliximab and temporarily stopping any calcineurin inhibitors until resuming treatment with an alternative calcineurin inhibitor.
Case Presentation:
A 58-year-old Asian woman underwent bilateral lung transplantation for hypersensitivity pneumonitis caused by an avian antigen, or bird fancier's lung disease. Postoperatively, she was started on triple immunosuppressive therapy, which included tacrolimus, mycophenolate mofetil, and steroids. On postoperative day 6, she developed thrombocytopenia followed by fever, hemolytic anemia, renal dysfunction, and purpura on her limbs and abdomen. She was diagnosed with transplant-associated thrombotic microangiopathy, and tacrolimus was thought to be the causal agent. We stopped tacrolimus and administered basiliximab. Then, she developed oliguria and needed continuous hemodiafiltration. On postoperative day 14, the platelet count recovered and she was switched from basiliximab to cyclosporine. Using this protocol, worsening thrombotic microangiopathy and acute rejection were avoided.
Conclusions:
We report the case of a patient with early post-transplant thrombotic microangiopathy after lung transplantation that was treated with basiliximab. Switching from calcineurin inhibitors using basiliximab may be an option for treating thrombotic microangiopathy without increasing the risk of acute rejection.
Insights
Early transplant-associated thrombotic microangiopathy after lung transplant was successfully treated by stopping calcineurin inhibitors and introducing basiliximab. This approach avoided acute rejection and resolved thrombotic microangiopathy symptoms.
Area of Science:
- Nephrology
- Transplantation Immunology
- Hematology
Background:
- Thrombotic microangiopathy (TMA) involves microangiopathic hemolytic anemia and platelet aggregation due to endothelial injury and thrombosis.
- Transplant-associated thrombotic microangiopathy (TA-TMA) is rare after lung transplantation, typically occurring later than after other transplants.
- Standard treatment for TA-TMA involves discontinuing the causative agent, often a calcineurin inhibitor like tacrolimus or cyclosporine.
Purpose of the Study:
- To report a case of early TA-TMA following lung transplantation.
- To describe a treatment strategy involving basiliximab and temporary calcineurin inhibitor withdrawal.
- To evaluate the efficacy of this strategy in managing TA-TMA without compromising graft survival.
Main Methods:
- A 58-year-old woman received a bilateral lung transplant for hypersensitivity pneumonitis.
- Postoperatively, she developed TA-TMA on day 6, characterized by thrombocytopenia, fever, hemolytic anemia, renal dysfunction, and purpura.
- Treatment involved stopping tacrolimus, administering basiliximab, followed by a switch to cyclosporine.
Main Results:
- The patient required continuous hemodiafiltration due to oliguria.
- Platelet count recovered by postoperative day 14 after basiliximab administration.
- The switch to cyclosporine successfully managed TA-TMA and avoided acute rejection.
Conclusions:
- Basiliximab can be a viable option for treating early TA-TMA post-lung transplantation.
- Switching from calcineurin inhibitors with basiliximab may manage TA-TMA without increasing acute rejection risk.
- This case highlights an alternative therapeutic approach for managing TA-TMA in lung transplant recipients.
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