Immune Thrombocytopenia in a Kidney Transplant Recipient Treated with Romiplostim

We present a case of immune thrombocytopenia following a living donor kidney transplant. Thrombocytopenia started two days after transplant and continued up to seven weeks after transplant, despite an extensive workup, treatment with steroids, intravenous immune globulin, and alterations in immunosuppression and other medications. In the absence of platelet transfusions, the patient's platelet count remained < 20,000/mm³. Platelet count responded to romiplistim (Nplate®, Amgen Inc.) within two weeks and has remained stable for twelve months after initiation of this agent. The patient's graft function has also been stable. This experience suggests romiplostim is safe and effective for persistent immune thrombocytopenia in kidney transplant recipients.