Thrombotic microangiopathy: recurrence following renal transplant and response to plasma infusion

Recurrence of thrombotic microangiopathy (TMA) has rarely been reported following renal transplantation. We describe a 24-year-old man who developed irreversible renal failure due to thrombotic microangiopathy. Following renal transplantation, he developed recurrent episodes of microangiopathic hemolysis; during one of these episodes a biopsy revealed the development of thrombotic microangiopathy in the graft. In each of five recurrences to date, plasma infusion, either alone or combined with other forms of therapy, has produced a prompt remission. This is the first report, to our knowledge, of the successful treatment of recurrent TMA in a renal transplant recipient.