title: Renal thrombotic microangiopathy associated with chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.
abstract: Thrombotic microangiopathy (TMA) is a major complication after hematopoietic stem cell transplantation (HSCT). In this study, we examined the clinical and pathologic features of 2 patients and 5 autopsy cases with HSCT-associated renal TMA to clarify the association between graft-versus-host disease (GVHD) and renal TMA. The median interval between HSCT and renal biopsy or autopsy was 7 months (range 3-42 months). Clinically, acute and chronic GVHD occurred in 7 and 4 patients, respectively. Clinical evidence for TMA was detected in 2 patients, while chronic kidney disease developed in all patients. The main histopathological findings were diffuse endothelial injury in glomeruli, peritubular capillaries (PTCs), and small arteries. In addition, all cases showed glomerulitis, renal tubulitis, and peritubular capillaritis with infiltration of CD3+ T cells and TIA-1+ cytotoxic cells, suggesting that GVHD occurred during the development of TMA. Diffuse and patchy C4d deposition was noted in glomerular capillaries and PTCs, respectively, in 2 biopsy and 2 autopsy cases, suggesting the involvement of antibody-mediated renal endothelial injury in more than 50% of renal TMA cases. In conclusion, the kidney is a potential target of chronic GVHD that may induce the development of HSCT-associated TMA. Importantly, some cases are associated with chronic humoral GVHD.
authors: Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan.
authors: Akiko
authors: A
authors: Mii
authors: Akira
authors: A
authors: Shimizu
authors: Tomohiro
authors: T
authors: Kaneko
authors: Emiko
authors: E
authors: Fujita
authors: Megumi
authors: M
authors: Fukui
authors: Teppei
authors: T
authors: Fujino
authors: Kouichi
authors: K
authors: Utsumi
authors: Hiroki
authors: H
authors: Yamaguchi
authors: Kenji
authors: K
authors: Tajika
authors: Shin-ichi
authors: S
authors: Tsuchiya
authors: Yasuhiko
authors: Y
authors: Iino
authors: Yasuo
authors: Y
authors: Katayama
authors: Yuh
authors: Y
authors: Fukuda
mesh_terms: D000328:Adult; D001160:Arterioles / Q000473:pathology; D001344:Autopsy; D001706:Biopsy; D015935:Complement C4b / Q000276:immunology; D006086:Graft vs Host Disease / Q000150:complications* / Q000276:immunology / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007150:Immunohistochemistry; D007668:Kidney / Q000276:immunology / Q000473:pathology*; D007674:Kidney Diseases / Q000150:complications* / Q000276:immunology / Q000473:pathology; D007678:Kidney Glomerulus / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000276:immunology; D057049:Thrombotic Microangiopathies / Q000150:complications* / Q000276:immunology / Q000473:pathology; D013997:Time Factors; D014184:Transplantation, Homologous
chemical_list: D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d