Tacrolimus-induced thrombotic microangiopathy (TMA) after heart and lung transplantation successfully treated with eculizumab.

Background: Tacrolimus-induced thrombotic microangiopathy (TMA) causing acute kidney injury (AKI) without systemic features is a rare entity, particularly after non-renal solid organ transplantation.

Methods: We describe the case of a patient with AKI after combined heart and lung transplantation. Renal biopsy revealed acute thrombotic microangiopathy which ultimately prompted initiation of eculizumab, a monoclonal antibody targeted against complement C5, with subsequent recovery in renal function.

Conclusions: This case highlights renal isolated drug-induced TMA as a rarely reported cause of AKI post heart-lung transplantation. We emphasize the importance of performing a renal biopsy in guiding management strategies.