Management of Tacrolimus-induced thrombotic microangiopathy in a heart transplant recipient: Utilizing novel immunosuppression strategies.

Thrombotic microangiopathy (TMA) represents a heterogeneous group of disorders characterized by endothelial injury, complement activation, and platelet aggregation, and may occur in association with systemic diseases, infections, or drug exposure. In solid organ transplant recipients, TMA is most commonly linked to immunosuppressive therapy, particularly calcineurin inhibitors and mammalian target of rapamycin inhibitors, with increased risk during combined use. Drug-induced TMA is rare but potentially life-threatening, and management relies primarily on prompt withdrawal of the offending agent and modification of immunosuppression. We report the successful use of belatacept-based immunosuppression in a heart transplant recipient with tacrolimus-associated TMA. Belatacept, a selective T-cell costimulation blocker, represents a promising alternative immunosuppressive strategy in this setting, particularly in patients with drug-related vascular toxicity.