Thrombotic microangiopathy after kidney transplantation

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Thrombotic microangiopathy (TMA) is a severe complication of kidney transplantation that often causes graft failure. TMA may occur de novo, often triggered by immunosuppressive drugs and acute antibody-mediated rejection, or recur in patients with previous history of hemolytic uremic syndrome (HUS). Recurrent TMA is very rare in patients who had developed end-stage renal failure following HUS caused by Shiga-toxin producing E. scherichia coli, whereas disease recurrence is common in patients with atypical HUS (aHUS). The underlying genetic defect greatly impacts the risk of posttransplant recurrence in aHUS. Indeed recurrence is almost the rule in patients with mutations in genes encoding factor H or factor I, whereas patients with a mutation in membrane-cofactor-protein gene have a good transplant outcome. Prophylactic and therapeutic options for posttransplant TMA, including plasma therapy, combined kidney and liver transplantation and targeted complement inhibitors are discussed in this review.

Original languageEnglish
Pages (from-to)1517-1523
Number of pages7
JournalAmerican Journal of Transplantation
Volume10
Issue number7
DOIs
Publication statusPublished - Jul 2010

Fingerprint

Thrombotic Microangiopathies
Kidney Transplantation
Hemolytic-Uremic Syndrome
Complement Inactivating Agents
Recurrence
CD46 Antigens
Shiga Toxin
Transplants
Complement Factor H
Mutation
Immunosuppressive Agents
Liver Transplantation
Genes
Chronic Kidney Failure
Escherichia coli
Antibodies
Therapeutics
Pharmaceutical Preparations

Keywords

  • Complement activation
  • hemolytic uremic syndrome
  • kidney transplantation
  • thrombotic microangiopathy

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Thrombotic microangiopathy after kidney transplantation. / Noris, M.; Remuzzi, G.

In: American Journal of Transplantation, Vol. 10, No. 7, 07.2010, p. 1517-1523.

Research output: Contribution to journalArticle

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