Severe sirolimus-related inflammatory state anemia in an HIV+ liver transplant patient with calcineurin inhibitor renal insufficiency: a case report.


Journal Article

Although multifactorial anemia is common following orthotopic liver transplantation (OLT), the late introduction of sirolimus (SRL) has been associated with high rates of anemia, whose pathogenic mechanisms have not been fully studied. Herein we have described a case of severe anemia in an HIV+ OLT patient who was switched from calcineurin inhibitors (CNI) to SRL due to severe nephrotoxicity. After 22 weeks of SRL, hemoglobin levels dropped 4 g/dL to a nadir of 6.5 g/dL. After discarding other causes for anemia, we concluded that it displayed the features of anemia of a chronic inflammatory state (ACIS): decreased mean corpuscular volume (MCV), low serum iron despite high ferritinemia, and elevated fibrinogen and C-reactive protein (CRP) levels. SRL trough levels were never above the therapeutic range. After blood transfusions and erythropoietin (EPO) use, SRL was maintained within the lower range of therapeutic levels, with significant improvement in renal function. As described among kidney transplant recipients, SRL-related anemia in this HIV+ patient with CNI nephrotoxicity after OLT showed features of ACIS. Blood transfusions and EPO use allowed SRL maintenance.

Full Text

Cited Authors

  • Moreno, A; Bárcena, R; García-Gonzalez, M; García-Hoz, F; Quereda, C; Casado, JL; Pérez-Elías, MJ; Fortún, J; Nuño, J; Arranz, I; Moreno, S

Published Date

  • December 2008

Published In

Volume / Issue

  • 40 / 10

Start / End Page

  • 3810 - 3812

PubMed ID

  • 19100499

Pubmed Central ID

  • 19100499

Electronic International Standard Serial Number (EISSN)

  • 1873-2623

International Standard Serial Number (ISSN)

  • 0041-1345

Digital Object Identifier (DOI)

  • 10.1016/j.transproceed.2008.07.130


  • eng