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논문분류	춘계학술대회 초록집
제목	Remission of uremic thromobocytopenia that was resistant to Eltrombopag after kidney transplantation
저자	Jin Ho Lee1, Seun Deuk Hwang2, Joon Ho Song2, Hee Yeoun Kim1, Dong Yeol Lee1, Joon Seok Oh1, Yong Hun Sin1, Joong Kyung Kim1
출판정보	2018; 2018(1):
키워드	Thrombocytopenia \| Eltrombopag \| KTP
초록	Case Study: Introduction: Thrombocytopenia can occur in a variety of causes in patients with end-stage renal disease(ESRD) undergoing hemodialysis. Idiopathic thrombocytopenic purpura(ITP) refers to thrombocytopenia whose cause is unknown even after bone marrow biopsy. Eltrombopag(GlaxoSmithKline, London, UK) was recently used in the treatment of ITP. It is an oral thrombopoietin-receptor agonist and induces platelet proliferation and differentiation by initiating thrombopoietin-receptor. We announced that a patient was taking eltrombopag due to steroid resistant ITP, and the medication was discontinued after a successful kidney transplant. Case: A 60-year-old woman diagnosed with diabetic ESRD in 2008 underwent hemodialysis three times a week. From Sep., 2015, the patient's platelet count has decreased to 10,000/mm3. Her dialysis efficiency was normal and did not show any abnormality in laboratory tests or bone marrow biopsy(Fig.1). Eltrombopag 25 mg was administered once a day because of resistance to steroid therapy. Although the drug was expensive(35,000 won or 31 US dollars/tablet), the number of platelets increased effectively up to 100,000/mm3 after administration. After that, the patient received a deceased donor kidney transplant on August 16, 2016. Thymoglobulin 50 mg iv was used for induction immunosuppressant(IS) for 3 days. Maintenance IS were calcineurin inhibitor, mycophenolate mofetil, and steroids. After KT, the patient maintained a normal platelet level and Eltrombopag was stopped immediately. After 9 months, the patient maintained normal kidney function and platelet count was maintained at 200,000/mm3.(Fig.2) Conclusion:. The steroid-resistant uremic thrombocytopenia has only a partial effect on the use of expensive eltrombopag in ESRD pateint. However, after kidney transplantation, platelets showed normal findings even if all medications were discontinued. Bone marrow biopsy
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