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World J Transplant. Jun 18, 2026; 16(2): 115114
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.115114
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.115114
Gemcitabine-sirolimus synergy associated thrombotic microangiopathy in a renal transplant recipient with mesenteric leiomyosarcoma: A case report
Vishaal Motla, Laura Mulloy, Talal Nakkar, Shameem Beigh, Imran Gani, Department of Nephrology, Hypertension and Transplant Medicine, Wellstar MCG Health, Augusta University, Augusta, GA 30912, United States
Usman Baig, Independent Researcher, Atlanta, GA 30308, United States
Author contributions: Motla V contributed to initial draft writing, literature review; Baig U contributed to extensive literature review and compilation, manuscript editing; Mulloy L, Nakkar T, and Beigh S contributed to clinical management of the patient and feedback; Gani I contributed to clinical management of the patient, case report clinical information, case report and discussion compilation, final editing of manuscript; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Imran Gani, MD, Associate Professor, Department of Nephrology, Hypertension and Transplant Medicine, Wellstar MCG Health, Augusta University, 1120 15th St, Augusta, GA 30912, United States. igani@augusta.edu
Received: October 13, 2025
Revised: November 22, 2025
Accepted: January 28, 2026
Published online: June 18, 2026
Processing time: 233 Days and 11.6 Hours
Revised: November 22, 2025
Accepted: January 28, 2026
Published online: June 18, 2026
Processing time: 233 Days and 11.6 Hours
Core Tip
Core Tip: Thrombotic microangiopathy represents a rare yet serious complication in renal transplant patients, potentially causing rapid loss of allograft function. Various medications, including gemcitabine and sirolimus, have been implicated in its pathogenesis. Even with discontinuation of causative agents and anticomplement therapy, allograft function may progressively worsen.