Asian Journal of Research in Nephrology

Immune thrombocytopenic purpura (ITP) is an exceptional autoimmune hematological abnormality in renal transplantation, marked by isolated thrombocytopenia and a high hemorrhagic risk.

We report in the form of a clinical case, A 24-year-old man with no notable medical history was managed in 2013 for chronic kidney failure of unknown cause, requiring long-term hemodialysis. In 2014, an isolated thrombocytopenia was incidentally found, fluctuating between 23,000 and 45,000/ μL. The etiological workup (infectious, immunological, myelogram) came back normal, arguing for a diagnosis of primary ITP.

At the time of diagnosis of immune thrombocytopenia, the patient was started on oral corticosteroids (1 mg/kg/day). However, the treatment was not effective in maintaining an adequate platelet count. A transient response was observed only at high doses, and any attempt to reduce the dose resulted in a rapid decline in platelet levels. This lack of sustained response and steroid dependence led to the introduction of eltrombopag (50 mg/day), which resulted in a rapid and marked increase in platelet count."

Eltrombopag was later discontinued as the patient remained asymptomatic despite persistent thrombocytopenia, without any bleeding or thrombotic events. Several years later, when a kidney transplant was planned with his HLA semi-identical father as a living donor, eltrombopag was reintroduced. Once again, it led to a rapid increase in platelet count within eight days, allowing the transplantation to be performed safely and without complication.

Transplantation was performed under thymoglobulin induction, followed by maintenance with tacrolimus, mycophenolate mofetil and prednisone. Treatment with eltrombopag was maintained for three weeks postoperatively. Graft function was stable (creatinine 14 mg/L) and platelets remained within normal limits.