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[Management of transplant-associated thrombotic microangiopathy]

Takayuki Ikezoe1

  • 1Fukushima Medical University.

[Rinsho Ketsueki] the Japanese Journal of Clinical Hematology
|October 12, 2018
PubMed

Insights

Transplant-associated thrombotic microangiopathy (TA-TMA) is a serious complication characterized by anemia, low platelets, and organ damage. This review covers its causes, diagnosis, and treatments for this potentially fatal condition.

Area of Science:

  • Hematology
  • Transplantation Immunology
  • Oncology

Background:

  • Transplant-associated thrombotic microangiopathy (TA-TMA) presents with microangiopathic hemolytic anemia, thrombocytopenia, and organ dysfunction due to microvascular thrombosis.
  • Vascular endothelial damage from chemotherapy, radiation, immunosuppressants, infections, and complement activation underlies TA-TMA pathogenesis.
  • TA-TMA affects 15-30% of allogeneic transplant patients, with severe cases exhibiting 100% mortality.

Purpose of the Study:

  • To review the current understanding of TA-TMA pathogenesis.
  • To outline diagnostic criteria for TA-TMA.
  • To discuss established and emerging treatment strategies for TA-TMA.

Main Methods:

  • Literature review of TA-TMA.
  • Synthesis of current knowledge on TA-TMA pathogenesis.
  • Analysis of diagnostic criteria and treatment options.

Main Results:

  • TA-TMA is triggered by diverse insults to vascular endothelium post-transplant.
  • Diagnosis relies on characteristic clinical and laboratory findings.
  • Treatment strategies are evolving, addressing underlying causes and thrombotic events.

Conclusions:

  • TA-TMA is a critical complication of allogeneic transplantation with significant morbidity and mortality.
  • A comprehensive understanding of pathogenesis is crucial for timely diagnosis and effective management.
  • Further research is needed to optimize treatment protocols and improve patient outcomes.
Keywords:
DefibrotideEndothelial insultTransplant-associated thrombotic microangiopathythrombomodulin

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