Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Oct;55(8):1866-1869.
doi: 10.1016/j.transproceed.2023.03.072. Epub 2023 Apr 6.

Sustained Response to Eculizumab in a Patient With COVID-19-Associated Acute Thrombotic Microangiopathy of the Allograft Kidney: A Case Report

Shehzad Rehman  1 , Angelo de Mattos  2 , Megan Stack  2 , Douglas Norman  3 , Sarah Zapata  4 , Pei Li Wang  4 , Abdul Hai Mansoor  4 , Vanderlene Kung  5 , Nicole K Andeen  5
Affiliations
Case Reports

Sustained Response to Eculizumab in a Patient With COVID-19-Associated Acute Thrombotic Microangiopathy of the Allograft Kidney: A Case Report

Shehzad Rehman et al. Transplant Proc. 2023 Oct.

Abstract

Acute thrombotic microangiopathy (TMA) developing in association with SARS-CoV-2 infection is a rare but recognized phenomenon in native kidneys. In the allograft kidney, a diagnosis of TMA has a broad etiologic differential, including antibody-mediated rejection and recurrent and de novo causes of TMA that affect the native kidney. Prior case reports have described plasma exchange or eculizumab use in patients with COVID-19-associated TMA. Herein, we describe the course of a kidney transplant patient with COVID-19-associated TMA with response to eculizumab that was sustained after medication withdrawal and review the literature on COVID-19-associated TMA of the allograft kidney.

PubMed Disclaimer

Conflict of interest statement

DISCLOSURES The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig 1
Post-COVID acute thrombotic microangiopathy in a kidney allograft, with (A) glomerular fibrin thrombus and mesangiolysis. There is no glomerulitis; the background tubulointerstitium is without tubulitis, active interstitial inflammation, or peritubular capillaritis (Jones, 200×). (B) Arterioles show mucoid intimal edema, red blood cell fragmentation, and fibrin thrombi; arteries were without endotheliitis (Jones, 200×).
Fig 2
Fig 2
The course of COVID-19–associated thrombotic microangiopathy in the kidney allograft and response to eculizumab. TMA, thrombotic microangiopathy.
See this image and copyright information in PMC

References

    1. Legrand M, Bell S, Forni L, Joannidis M, Koyner JL, Liu K, et al. Pathophysiology of COVID-19-associated acute kidney injury. Nat Rev Nephrol. 2021;17:751–764. - PMC - PubMed
    1. Demir E, Ucar ZA, Dheir H, Danis R, Yelken B, Uyar M, et al. COVID-19 in kidney transplant recipients: a multicenter experience from the first two waves of pandemic. BMC Nephrol. 2022;23:183. - PMC - PubMed
    1. Sagnelli C, Sica A, Gallo M, Peluso G, Varlese F, D'Alessandro V, et al. Renal involvement in COVID-19: focus on kidney transplant sector. Infection. 2021;49:1265–1275. - PMC - PubMed
    1. Daniel E, Sekulic M, Kudose S, Kubin C, Ye X, Shayan K, et al. Kidney allograft biopsy findings after COVID-19. Am J Transplant. 2021;21:4032–4042. - PMC - PubMed
    1. Bascunana A, Mijaylova A, Vega A, Macias N, Verde E, Rodriguez-Ferrero ML, et al. Thrombotic microangiopathy in a kidney transplant patient with COVID-19. Kidney Med. 2021;3:124–127. - PMC - PubMed

Publication types