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Review
. 2018 Jul;32(3):119-126.
doi: 10.1016/j.trre.2018.01.001. Epub 2018 Feb 10.

Innate networking: Thrombotic microangiopathy, the activation of coagulation and complement in the sensitized kidney transplant recipient

Miriam Manook  1 , Jean Kwun  2 , Steven Sacks  3 , Anthony Dorling  3 , Nizam Mamode  4 , Stuart Knechtle  5
Affiliations
Review

Innate networking: Thrombotic microangiopathy, the activation of coagulation and complement in the sensitized kidney transplant recipient

Miriam Manook et al. Transplant Rev (Orlando). 2018 Jul.

Abstract

Thrombotic microangiopathy (TMA) is a histological feature of antibody-mediated rejection and has the potential to cause problematic graft dysfunction, particularly for highly sensitized cross-match positive kidney transplant recipients. Prompt recognition of pertinent histopathological and systemic features of TMA in kidney transplantation is necessary. Underlying mechanisms of this process involve the activation of both complement and coagulation systems as a response to HLA antibody. As serine proteases, coagulation and complement cascades exhibit similar characteristics with respect to homeostatic function. Increasing evidence now exists for the interaction between these innate defenses in both activation and regulation, lending scope for intervention. Understanding the complexities of these interactions remains a challenge. This review provides an overview of the current understanding, particularly with respect to the activation of coagulation and complement by HLA antibody in the setting of highly sensitized kidney transplantation.

Keywords: Antibody incompatible transplantation; Coagulation; Complement; HLA-incompatible transplantation; Highly sensitized; Kidney transplantation; Thrombotic microangiopathy.

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Conflict of interest statement

Conflict of Interest:

The authors declare no conflict of interest.

Figures

Figure 1:
Figure 1:
Complement Cascade.
Figure 2:
Figure 2:
Coagulation Cascade.
Figure 3:
Figure 3:
Complement and Coagulation Crosstalk in Thrombotic Microangiopathy in the Highly Sensitized Transplant Recipient.
See this image and copyright information in PMC

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