Thrombotic microangiopathy after kidney transplantion

Authors

  • Mohammad Sami Tahseen MBChB, FKBMS (Int. Med), KHCMS (Neph) Trainee
  • Safa Ezzeddin Nouruldin FICMS (Int. Med), FICMS (Neph), FRCP(Edin) Associate professor of medicine and nephrology

DOI:

https://doi.org/10.56056/amj.2023.225

Keywords:

CNI toxicity, Kidney transplantation, Thrombotic microangiopathy

Abstract

Background and objectives: Thrombotic microangiopathy after kidney transplantation is rare but serious complication. The purpose of this study is to describe the cases of thrombotic microangiopathy after kidney transplantation.

Patients and Methods: This retrospective study used the reports of all kidney transplant biopsies that were done in Kurdistan region from January 2017 to April 2022. The biopsy reports with diagnosis of Thrombotic microangiopathy were extracted from this total number and the patients, and pathological data included in the reports were recorded.

Results: The total number of 1635 graft biopsies, of which 82 (5.01%) were found to have Thrombotic microangiopathy features. The mean age of studied patients with Thrombotic microangiopathy was (38.2 years) and male to female ratio as 2.3:1. We found 67.1% of cases of Thrombotic microangiopathy were associated with calcineurin inhibitor toxicity, 35.4% with rejection, 15.9% were recurrent thrombotic microangiopathy, and 40.2% were associated with other miscellaneous causes.

Conclusions: Thrombotic microangiopathy after kidney transplantation is rare but debilitating complication. The cause is multifactorial in most cases in the light of coexistence of multiple risk factors in the kidney transplant recipients. Further studies are required to disentangle these overlapping risk factors. And allow for better prevention and treatment of this condition.

Downloads

Download data is not yet available.

References

Noris M, Remuzzi G. Thrombotic Microangiopathy after Kidney Transplantation. Am J Transplant. 2010; 10(7): 1517-23.

Ganesh K, Abraham M, Kumar J, et al.Thrombotic microangiopathies postrenal transplantation. Indian J Transplant 2020; 14(3): 213.

Abbas F, Kossi ME, Kim JJ, et al. Thrombotic microangiopathy after renal transplantation: Current insights in de novo and recurrent disease. World J Transplant 2018; 8(5): 122–41.

Pham P-TT, Danovitch GM, Wilkinson AH, et al. Inhibitors of ADAMTS13: A potential factor in the cause of thrombotic microangiopathy in a renal allograft recipient. Transplantation. 2002; 74(8): 1077–80.

Garg N, Rennke HG, Pavlakis M, et al. De novo thrombotic microangiopathy after kidney transplantation. Transplant Rev. 2018; 32(1): 58–68.

Reynolds JC, Agodoa LY, Yuan CM, et al. Thrombotic microangiopathy after renal transplantation in the United States1 1 The opinions expressed are solely those of the authors and do not represent an endorsement by the Department of Defense or the National Institutes of Health. This is a US government work. There are no restrictions on its use. Am J Kidney Dis. 2003; 42(5): 1058–68.

Teixeira CM, Silva Junior HT, Moura LA, et al. Clinical and pathological features of thrombotic microangiopathy influencing long-term kidney transplant outcomes. PLOS ONE. 2020; 15(1). 0227445.

Zarifian A, Meleg-Smith S, O'Donovan R, et al. Cyclosporine-associated thrombotic microangiopathy in renal allografts. Kidney Int. 1999; 55(6): 2457–66.

Karthikeyan V, Parasuraman R, Shah V, et al. Outcome of plasma exchange therapy in thrombotic microangiopathy after renal transplantation. Am J Transplant2003; 3(10): 1289–94.

Satoskar AA, Pelletier R, Adams P, et al. De novo thrombotic microangiopathy in renal allograft biopsies-role of antibody-mediated rejection. Am J Transplant2010; 10(8): 1804–11.

Wu K, Budde K, Schmidt D, et al. The inferior impact of antibody-mediated rejection on the clinical outcome of kidney allografts that develop de novo thrombotic microangiopathy. Clin Transplant. 2016; 30(2): 105–17.

Bayer G, von Tokarski F, Thoreau B, et al. Etiology and outcomes of thrombotic Microangiopathies. Clin J Am Soc Nephrol. 2019; 14(4): 557–66.

Nava F, Cappelli G, Mori G, et al. Everolimus, cyclosporine, and thrombotic microangiopathy: Clinical role and preventive tools in renal transplantation. Transplant Proc. 2014; 46(7): 2263–8.

Ávila A, Gavela E, Sancho A. Thrombotic microangiopathy after kidney transplantation: an underdiagnosed and potentially reversible entity. Front Med (Lausanne). 2021 Apr 8; 8: 642864.

Goodship THJ, Cook HT, Fakhouri F, et al. Atypical hemolytic uremic syndrome and C3 glomerulopathy: Conclusions from a (KDIGO) controversies conference. Kidney Int. 2017; 91(3): 539–51.

Bresin E, Daina E, Noris M, et al. Outcome of renal transplantation in patients with non–shiga toxin–associated hemolytic uremic syndrome: Prognostic significance of genetic background. Clin J Am Soc Nephrol. 2005; 1(1): 88–99.

Le Quintrec M, Zuber J, Moulin B, et al. Complement Genes Strongly Predict Recurrence and Graft Outcome in Adult Renal Transplant Recipients with Atypical Hemolytic and Uremic Syndrome. Ame, Jor. Trans. 2013; 13(3): 663-675.

Loirat C, Fakhouri F, Ariceta G, et al. An international consensus approach to the management of atypical hemolytic uremic syndrome in children. Pediatr Nephrol. 2015; 31(1): 15-39.

Le Quintrec M, Zuber J, Moulin B, et al. Complement Genes Strongly Predict Recurrence and Graft Outcome in Adult Renal Transplant Recipients with Atypical Hemolytic and Uremic Syndrome. Am J Transplant. 2013; 13(3): 663-75.

Hariharan S, Adams MB, Brennan DC, et al. Recurrent and de novo glomerular disease after renal transplantation: a report from (RADR) 1, 2. Transplantation. 1999; 68(5): 635-41.

Bleyer A, Donaldson L, McIntosh M, et al. Relationship between underlying renal disease and renal transplantation outcome. Am J Transplant. 2001; 37(6): 1152-161.

Moll S, Taylor M, Krizek D, et al. Clinical Use of a Rapid Collagen Binding Assay for von Willebrand Factor Cleaving Protease in Patients with Thrombotic Thrombocytopenic Purpura. Thromb Haemost. 2002; 88(10): 598-604.

Tsai H. Deficiency of ADAMTS13 and thrombotic thrombocytopenic purpura. Transfusion. 2002; 42(11): 1523-4.

Ferraris J, Ramirez J, Ruiz S, et al. Shiga toxin-associated hemolytic uremic syndrome: Absence of recurrence after Renal Transplantation. Pediatr Nephrol. 2002; 17(10): 809–14.

Lahlou A, Lang P, Charpentier B, et al. Hemolytic uremic syndrome: Recurrence after renal transplantation. Medicine. 2000; 79(2): 90–102.

Schwimmer J, Nadasdy TA, Spitalnik PF, et al. De novo thrombotic microangiopathy in renal transplant recipients: A comparison of hemolytic uremic syndrome with localized renal thrombotic microangiopathy. Am J Kidney Dis. 2003; 41(2): 471–9.

Teixeira CI, Mota RG, Afonso BG, et al. Use of eculizumab in atypical hemolytic uremic syndrome after Renal Transplantation. J Bras Nefrol. 2015; 37(1): 127-30

Kaul A, Saikumar Doradla LP, Lal H, et al. Clinical profile and outcomes of de novo posttransplant thrombotic microangiopathy. Saudi J Kidney Dis Transpl 2020; 31(1): 160-8.

Chua S, Wong G, Lim WH. The importance of genetic mutation screening to determine retransplantation following failed kidney allograft from recurrent atypical haemolytic ureamic syndrome. Case Reports. BMJ Case Rep. 2014; 2014: bcr2013202875.

Sánchez Chinchilla D, Pinto S, Hoppe B, et al. Complement mutations in diacylglycerol kinase-?–associated atypical hemolytic uremic syndrome. Clin J Am Soc Nephrol. 2014; 9(9): 1611–9.

Downloads

Published

2023-12-05

How to Cite

Tahseen, M. S., & Nouruldin, S. E. . (2023). Thrombotic microangiopathy after kidney transplantion. AMJ (Advanced Medical Journal) , 8(2), 116-124. https://doi.org/10.56056/amj.2023.225

Issue

Section

Articles