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
. 2024 Nov 28;25(1):433.
doi: 10.1186/s12882-024-03846-x.

The outcome of thrombotic microangiopathy in kidney transplant recipients

Kanza Haq  1 , Shanshan Lin  2 , Alana Dasgupta  3 , Zainab Obaidi  4 , Serena Bagnasco  5 , Umberto Maggiore  6 , Nada Alachkar  7
Affiliations

The outcome of thrombotic microangiopathy in kidney transplant recipients

Kanza Haq et al. BMC Nephrol. .

Abstract

Background: The outcome of kidney transplant recipients with a history of complement-mediated thrombotic microangiopathy (cTMA) and those who develop post-transplant de novo TMA (dnTMA) is largely unknown.

Methods: We retrospectively studied all kidney transplant recipients with end-stage kidney disease secondary to cTMA and those who developed dnTMA, between Jan 2000 and Dec 2020 in our center.

Results: We identified 134 patients, 22 with cTMA and 112 had dnTMA. Patients with cTMA were younger at the time of TMA diagnosis (age at diagnosis, 28.9 ± 16.3. vs 46.5 ± 16.0 years; P < 0.001). T-cell mediated rejection, borderline rejection, and calcineurin inhibitor toxicity were more prevalent in the first kidney transplant biopsy (P < 0.05) in the dnTMA group, and antibody-mediated rejection was more prevalent in anytime-biopsy (P = 0.027). After adjusting for potential confounders, cTMA was associated with a sixfold increase in the hazard of transplant failure during the first-year post-transplant (adjusted hazard ratio (aHR): 6.37 [95%CI: 2.17 to18.68; P = 0.001]; the aHR decreased by 0.87 (95% CI: 0.76 to 0.99: P = 0.033) per year elapsed since transplantation. Long-term allograft survival was similar in both groups.

Conclusion: Post kidney transplant TMA is an important cause of poor allograft survival. More studies are needed to enhance our understanding and management of this disorder.

Keywords: Complement-mediated TMA; De novo TMA; Kidney; Thrombotic Microangiopathy; Transplant.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The ethics committee is the Johns Hopkins Hospital’s Institutional Review Board. This is a retrospective study, data were collected from the electronic medical records, consents were waived by Johns Hopkins Hospital’s Institutional Review Board. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier plot of transplant survival (death or end-stage kidney disease, ESKD) of primary cTMA vs dnTMA. Time at risk starts from transplantation and includes patients with available follow-up. The population is divided into those who had known cTMA before transplantation (red) and those who had dnTMA (blue). There was a sudden drop by 10% in cTMA patients shortly after follow-up, but survival was similar between the groups in the long term; cTMA
Fig. 2
Fig. 2
Time-varying adjusted hazard ratio (HR) of transplant failure (death or end-stage kidney disease, ESKD) of patients with cTMA compared to dnTMA. The hazard ratio is highest shortly after transplantation, and then decreases with time. The model is adjusted for age, gender, ethnicity, donor type, induction with lymphodepleting agents, DGF, eculizumab use (any time), and biopsy diagnosis (time-varying cumulative sum). The line represents the hazard ratio estimates, the blue shaded area represents the 95 percent confidence interval; cTMA, complement-mediated thrombotic microangiopathy
Fig. 3
Fig. 3
Kaplan–Meier patient survival estimates in cTMA and dnTMA. Time at risk started from transplantation and included patients with available follow-up. Patients starting dialysis were censored
Fig. 4
Fig. 4
Kaplan–Meier allograft survival estimates according to the use of eculizumab
See this image and copyright information in PMC

References

    1. Hariharan S, Israni AK, Danovitch G. Long-Term Survival after Kidney Transplantation. N Engl J Med. 2021Aug 19;385(8):729–43. - PubMed
    1. Moake JL. Thrombotic microangiopathies. N Engl J Med. 2002Aug 22;347(8):589–600. - PubMed
    1. Ávila A, Gavela E, Sancho A. Thrombotic Microangiopathy After Kidney Transplantation: An Underdiagnosed and Potentially Reversible Entity. Front Med (Lausanne). 2021;8: 642864. - PMC - PubMed
    1. Zarifian A, Meleg-Smith S, O’donovan R, Tesi RJ, Batuman V. Cyclosporine-associated thrombotic microangiopathy in renal allografts. Kidney Int. 1999 Jun;55(6):2457–66. - PubMed
    1. Reynolds JC, Agodoa LY, Yuan CM, Abbott KC. Thrombotic microangiopathy after renal transplantation in the United States. Am J Kidney Dis. 2003Nov;42(5):1058–68. - PubMed