There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the FDA Drug Label
Thrombotic Microangiopathy Occasionally patients have developed a syndrome of thrombocytopenia and microangiopathic hemolytic anemia which may result in graft failure The vasculopathy can occur in the absence of rejection and is accompanied by avid platelet consumption within the graft as demonstrated by Indium 111 labeled platelet studies. Neither the pathogenesis nor the management of this syndrome is clear Though resolution has occurred after reduction or discontinuation of cyclosporine and 1) administration of streptokinase and heparin or 2) plasmapheresis, this appears to depend upon early detection with Indium 111 labeled platelet scans
The treatment for thrombotic microangiopathy (TMA) in a renal transplant patient on Cyclosporine may involve:
- Reduction or discontinuation of cyclosporine
- Administration of streptokinase and heparin
- Plasmapheresis It is essential to note that the management of this syndrome is not clearly defined, and resolution may depend on early detection with Indium 111 labeled platelet scans 1.
From the Research
Treatment for Thrombotic Microangiopathy (TMA) in Renal Transplant Patients on Cyclosporine
- The treatment for TMA in renal transplant patients on cyclosporine involves discontinuation or reduction of cyclosporine dose, with or without concurrent plasma exchange, plasma infusion, anticoagulation, and intravenous immunoglobulin G infusion 2.
- Cyclosporine withdrawal has been shown to be effective in salvaging the graft in some patients, especially when done at an early stage before significant functional deterioration has taken place 3.
- In some cases, switching to tacrolimus has been reported to be a viable therapeutic option in the setting of cyclosporine-induced TMA, but patients should be closely monitored for signs and symptoms of recurrent TMA 2.
- The use of a triple-drug combination of isradipine, aspirin, and pentoxifylline has been reported to allow for the successful reinstitution of cyclosporine or conversion to tacrolimus in the setting of TMA, resulting in increased transplant survival 4.
- It is essential to note that the treatment approach may vary depending on the individual patient's circumstances, and the decision to withdraw or reduce cyclosporine dose should be made on a case-by-case basis, taking into account the risk of precipitating acute rejection and graft loss 5, 2.
Considerations for Treatment
- The development of TMA is a rare but serious complication of renal transplantation, and prompt recognition and treatment are crucial to prevent graft loss 6, 5.
- The mechanism of cyclosporine-induced TMA is unknown, but factors intrinsic to the donor kidney appear to play an important role 5.
- Patients who develop TMA should be closely monitored for signs and symptoms of recurrent TMA, especially if they are switched from cyclosporine to tacrolimus or vice versa 2.