Postrenal Transplant Hemolytic Uremic Syndrome/Thrombotic Microangiopathy: Ahmedabad Experience

Postrenal Transplant Hemolytic Uremic Syndrome/Thrombotic Microangiopathy: Ahmedabad Experience

Abstract Background Hemolytic uremic syndrome (HUS)/thrombotic microangiopathy (TMA) (tissue-limited HUS) is a well-recognized serious complication of renal transplantation, affecting 3% to 14% patients who are administered calcineurin inhibitor–based immunosuppression. We performed a retrospective...

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Published in:Transplantation proceedings Vol. 40; no. 4; pp. 1114 - 1116
Main Authors: Goplani, K.R, Vanikar, A.V, Shah, P.R, Gumber, M, Feroz, A, Patel, H.V, Kasat, P, Falodia, J, Saboo, D, Kaswaan, K, Geerish, M.S, Pandya, T, Trivedi, H.L
Format: Journal Article Conference Proceeding
Language:English
Published: New York, NY Elsevier Inc 01-05-2008
Elsevier Science
Subjects:
Biological and medical sciences
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Glomerular Mesangium - pathology
Hemolytic-Uremic Syndrome - epidemiology
Humans
Immunosuppressive Agents - adverse effects
Immunosuppressive Agents - therapeutic use
India
Kidney Transplantation - adverse effects
Kidney Transplantation - pathology
Medical sciences
Nephrology. Urinary tract diseases
Nephropathies. Renovascular diseases. Renal failure
Peripheral Vascular Diseases - epidemiology
Recurrence
Renal failure
Retrospective Studies
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Thrombosis - epidemiology
Tissue, organ and graft immunology
India
Kidney disease
Thrombocytopenia
Graft(material)
Urinary system disease
Hemolytic uremic syndrome
Acute
Cardiovascular disease
Hemopathy
Transplantation
Homotransplantation
Thrombohemolytic microangiopathy
Vascular disease
Medicine
Experience
Platelet
Hemolytic anemia
Treatment
Surgery
Renal failure
Graft
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Summary:Abstract Background Hemolytic uremic syndrome (HUS)/thrombotic microangiopathy (TMA) (tissue-limited HUS) is a well-recognized serious complication of renal transplantation, affecting 3% to 14% patients who are administered calcineurin inhibitor–based immunosuppression. We performed a retrospective study to examine the incidence, etiology, course, and outcome of HUS/TMA in our experience. Patients and Methods This retrospective study of 1540 renal allograft biopsies performed between January 2000 and October 2007 was performed to assess the incidence of HUS/TMA. Institute Transplant Registry records were reviewed for clinical history, laboratory findings, medications, and outcome. The offending drug was substituted in all subjects and plasmapheresis was added as an adjuvant until recovery of allograft function. Results TMA was observed in 17 (1.1%) biopsies. Two of 17 patients experienced recurrent HUS; 15 were drug-induced (12 with cyclosporine, three with Sirolimus); 10 were TMA; and five HUS. Nine patients developed HUS/TMA within 3 months of transplantation with eight developing it within 1 year posttransplantation. Graft function recovered in 12, while five did not recover. The HUS group showed 60% recovery compared with 80% among the TMA group. Two patients were lost; both displayed HCV seropositivity and one also showed anti-cardiolipin antibody. Conclusion Early allograft biopsy with prompt diagnosis and management by drug substitution ± plasmapheresis in posttransplant HUS/TMA plays an important role in allograft outcome. TMA showed better recovery than HUS.
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ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2008.03.028