CYTOKINE CHANGES IN THROMBOTIC THROMBOCYTOPENIC PURPURA FOLLOWING KIDNEY-TRANSPLANTATION

The occurrence of thrombotic thrombocytopenic purpura (TTP) following kidney transplantation is rare. We report a patient who developed TTP within 36 hours of kidney transplantation. For 5 months preoperatively, serum levels of Interleukin-2 (IL-2) and gamma interferon (IFN-G) were markedly elevated. Subsequent to kidney transplantation and steroid administration, thrombocytopenia, with schistocytic anemia and severe neurologic changes (TTP), abruptly occurred. This was associated with a dramatic fall in the levels of IL-2 and gamma-IFN. There was no clinical improvement with plasmapheresis. The patient's serum was not cytotoxic when added with complement to the donor renal vein endothelial cells in vitro. Removal of the allograft corrected the TTP.