Diagnostic and management dilemma of a pancreas–kidney transplant recipient with aplastic anaemia. (25th September 2014)

• Record Type: Journal Article
• Authors: Viecelli, Andrea; Hessamodini, Hannah; Augustson, Bradley; Lim, Wai Hon
• Is Part Of: BMJ case reports. Volume 2014
• Publication Date: 2014-09-25
• Subjects: Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2014-205076
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : We report a case of a 57-year-old woman with type I diabetes who had received a simultaneous pancreas–kidney (SPK) transplant maintained on tacrolimus, mycophenolic acid (MPA) and prednisolone. Her renal allograft failed 6 years post-transplant but she continued to have a normal functioning pancreatic allograft. Over the course of 5 years, she developed progressive bone marrow failure with repeat bone marrow aspirates demonstrating an evolution from erythroid hypoplasia to hypocellular marrow and eventual aplastic anaemia despite discontinuation of MPA and reduction of tacrolimus. She was transfusion-dependent and had frequent admissions for sepsis. Despite treatment with antithymocyte globulin and cyclosporine for aplastic anaemia, she developed fatal invasive pulmonary aspergillosis within 3 weeks of treatment. Even though the cause of aplastic anaemia is likely multifactorial, this case highlights the difficulty in balancing the need for versus the risk of ongoing immunosuppression in a SPK transplant recipient who continues to have normal pancreatic graft function.