Clinical and pathological features of thrombotic microangiopathy influencing long-term kidney transplant outcomes

English version

Autoři: Cínthia Montenegro Teixeira ^aff001; Hélio Tedesco Silva Junior ^aff001; Luiz Antônio Ribeiro de Moura ^aff002; Henrique Machado de Sousa Proença ^aff002; Renato de Marco ^aff003; Maria Gerbase de Lima ^aff003; Marina Pontello Cristelli ^aff001; Laila Almeida Viana ^aff001; Cláudia Rosso Felipe ^aff001; José Osmar Medina Pestana ^aff001
Působiště autorů: Nephrology Division, Federal University of São Paulo, São Paulo, Brazil ^aff001; Pathology Division, Hospital do Rim, Federal University of São Paulo, São Paulo, Brazil ^aff002; Immunogenetics Institute, AFIP, São Paulo, Brazil ^aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0227445

Souhrn

Introduction

Thrombotic microangiopathy (TMA) in post-transplant setting has heterogeneous clinical manifestations.

Methods

We retrospectively studied data of 89 patients with post-transplant TMA, which was characterized by thrombi in at least one glomerulus and/or arteriole. Systemic TMA was defined by thrombocytopenia and microangiopathic anemia and early onset TMA, when occurred less than 90 days post transplant.

Results

The cumulative incidence was 0.93%. The majority of the recipients were young (mean age 39 years), female (52%) and Caucasian (48%) with primary kidney disease of unknown etiology (37%). Early TMA occurred in 51% of the patients and systemic TMA, in 25%. Underlying precipitating factors were: infection (54%), acute rejection (34%), calcineurin inhibitor toxicity (13%) and pregnancy (3%). 18% of the patients had several triggers. Glomerular TMA was observed in 50% of the biopsies and endothelial cell activation, in 61%. The 1-year patient survival was 97% and corresponding graft survival, 66%. Allograft survival was inferior when acute antibody mediated rejection (ABMR) occurred (with 41%; without 70%, p = 0.01), however no differences were determined by hemolysis, time of onset, thrombi location or endothelial cell activation.

Conclusions

Our results suggest that post-transplant TMA is a rare but severe condition, regardless of its clinical and histological presentation, mainly when associated to ABMR.

Klíčová slova:

Kidneys – Renal transplantation – Endothelial cells – Glomerular filtration rate – Histology – Biopsy – Graft survival – Arterioles

Zdroje

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