Plasmapheresis for Thrombotic Microangiopathy Due to a Post-transplant Lymphoproliferative Disorder

We report a case of thrombotic microangiopathy (TMA) diagnosed in the kidney allograft of a 59-year-old woman who had developed plasmacytoma type monomorphic posttransplant lymphoproliferative disorder (PTLD) 30 years after a simultaneous pancreas and kidney transplant. This report demonstrates a rare etiology of TMA in a kidney allograft occurring in association with PTLD-associated monoclonal gammopathy. The main teaching points are: 1) PTLD may be considered in the work-up of a new TMA in the immunosuppressed post-transplant setting, and 2) a paraprotein-associated condition should be considered as clinically relevant coexistent in a patient with TMA because paraproteins are over-represented in patients with otherwise unexplained TMAs.