Thrombotic microangiopathy after kidney transplantation.
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.
Noris
M
M
Clinical Research Center for Rare Diseases 'Aldo e Cele Daccò', Mario Negri Institute for Pharmacological Research, Ranica, Bergamo, Italy. marina.noris@marionegri.it
Remuzzi
G
G
D001323:Autoantibodies / Q000235:genetics; D016913:Blood Component Transfusion; D002648:Child; D017242:Complement Factor H / Q000235:genetics; D003170:Complement Pathway, Alternative / Q000235:genetics; D003165:Complement System Proteins / Q000235:genetics; D004927:Escherichia coli Infections / Q000453:epidemiology; D005340:Fibrinogen / Q000235:genetics; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects; D009154:Mutation; D010949:Plasma; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D057049:Thrombotic Microangiopathies / Q000453:epidemiology*; D017211:Treatment Failure; D016896:Treatment Outcome
D001323:Autoantibodies; D017242:Complement Factor H; D005340:Fibrinogen; D003165:Complement System Proteins