Everolimus-Associated Thrombotic Microangiopathy Following Renal Transplant: A Case Report

Thrombotic microangiopathy (TMA) is a serious complication that may affect post-renal transplant recipients. De novo TMA has been linked to the use of transplant immunosuppressive agents, including calcineurin inhibitors (CNI) and mammalian target of rapamycin inhibitors (mTORi). We report a case of a 41-year-old female renal transplant recipient who presented with hemolytic anemia, thrombocytopenia, and acute allograft dysfunction. Before her presentation, she was on immunosuppression with oral tacrolimus, oral prednisolone, and oral everolimus. Her renal biopsy showed features of TMA, which led to extensive workup to identify the underlying cause. Eventually, everolimus was recognized as the cause of secondary TMA as her hemolytic parameters and renal allograft function recovered following discontinuation of this drug. This case report highlights the association of everolimus with TMA in a post-renal transplant patient. Early recognition and drug withdrawal can prevent allograft loss.