Renal thrombotic microangiopathy after hematopoietic cell transplant: role of GVHD in pathogenesis.
OBJECTIVE
Thrombotic microangiopathy (TMA) is a known complication of hematopoietic cell transplantation (HCT). The etiology and diagnosis of TMA in this patient population is often difficult because thrombocytopenia, microangiopathic hemolytic anemia, and kidney injury occur frequently in HCT recipients, and are the result of a variety of insults.


METHODS
The authors reviewed renal pathology and clinical data from HCT patients to determine the prevalence of TMA and to identify correlative factors for developing TMA in the kidney. Kidney tissue was evaluated from 314 consecutive autopsies on patients who died after their first HCT (received between 1992 and 1999). Renal pathology was classified into three groups: (1) no renal thrombus (65%), (2) TMA (20%), and (3) isolated thrombosis (15%). Logistic regression models estimated the associations between each histologic category and clinical parameters: donor and recipient gender, patient age, human leukocyte antigen (HLA) matching of the donor and recipient, total body irradiation (TBI), acute graft versus host disease (GVHD), acute kidney injury, medications, and viral infections.


RESULTS
In a multivariate analysis, TMA correlated with acute GVHD grades II to IV, followed by female recipient/male donor, TBI > 1200 cGy, and adenovirus infection. Grades II to IV acute GVHD and female gender were associated with isolated renal thrombus.


CONCLUSIONS
TMA in HCT recipients is associated with acute GVHD grades II to IV, recipient/donor mismatch, TBI > 1200 cGy, and adenovirus infection.
Changsirikulchai
Siribha
S
Department of Medicine, Srinakharinwirot University, Bangkok, Thailand.
Myerson
David
D
Guthrie
Katherine A
KA
McDonald
George B
GB
Alpers
Charles E
CE
Hingorani
Sangeeta R
SR
D000257:Adenoviridae Infections / Q000150:complications; D000293:Adolescent; D000328:Adult; D000368:Aged; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications* / Q000401:mortality / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007223:Infant; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011829:Radiation Dosage; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013921:Thrombocytopenia / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D013927:Thrombosis / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D055815:Young Adult