1. Clinical and pathological features of thrombotic microangiopathy influencing long-term kidney transplant outcomes
- Author
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Laila Almeida Viana, Marina Pontello Cristelli, Henrique Proença, Renato de Marco, Helio Tedesco Silva Junior, Claudia Rosso Felipe, Maria Gerbase de Lima, Luiz Antonio Ribeiro de Moura, Cinthia Montenegro Teixeira, and José Osmar Medina Pestana
- Subjects
Graft Rejection ,Male ,Physiology ,Biopsy ,030232 urology & nephrology ,030230 surgery ,urologic and male genital diseases ,Gastroenterology ,Epithelium ,0302 clinical medicine ,Pregnancy ,Animal Cells ,hemic and lymphatic diseases ,Medicine and Health Sciences ,Renal Transplantation ,Cumulative incidence ,Multidisciplinary ,medicine.diagnostic_test ,Incidence ,Graft Survival ,Middle Aged ,female genital diseases and pregnancy complications ,Arterioles ,Medicine ,Female ,Kidney Diseases ,Anatomy ,Cellular Types ,Research Article ,Glomerular Filtration Rate ,Adult ,medicine.medical_specialty ,Thrombotic microangiopathy ,Histology ,Science ,Renal function ,Surgical and Invasive Medical Procedures ,Infections ,Urinary System Procedures ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Pathological ,Retrospective Studies ,Transplantation ,Renal Physiology ,business.industry ,Thrombotic Microangiopathies ,Biology and Life Sciences ,Endothelial Cells ,Kidneys ,Epithelial Cells ,Organ Transplantation ,Renal System ,Cell Biology ,medicine.disease ,Kidney Transplantation ,Biological Tissue ,Etiology ,Cardiovascular Anatomy ,Blood Vessels ,business ,Kidney disease - Abstract
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.
- Published
- 2019