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Updated: Dec 31, 2025
Mouse Kidney Transplantation: Models of Allograft Rejection
Published on: October 11, 2014
Clinical and pathological features of thrombotic microangiopathy influencing long-term kidney transplant outcomes
Cínthia Montenegro Teixeira1, Hélio Tedesco Silva Junior1, Luiz Antônio Ribeiro de Moura2
1Nephrology Division, Federal University of São Paulo, São Paulo, Brazil.
Introduction:
Thrombotic microangiopathy (TMA) in post-transplant setting has heterogeneous clinical manifestations.
Methods:
We retrospectively studied data of 89 patients with post-transplant TMA, which was characterized by thrombi in at least one glomerulus and/or arteriole. Systemic TMA was defined by thrombocytopenia and microangiopathic anemia and early onset TMA, when occurred less than 90 days post transplant.
Results:
The cumulative incidence was 0.93%. The majority of the recipients were young (mean age 39 years), female (52%) and Caucasian (48%) with primary kidney disease of unknown etiology (37%). Early TMA occurred in 51% of the patients and systemic TMA, in 25%. Underlying precipitating factors were: infection (54%), acute rejection (34%), calcineurin inhibitor toxicity (13%) and pregnancy (3%). 18% of the patients had several triggers. Glomerular TMA was observed in 50% of the biopsies and endothelial cell activation, in 61%. The 1-year patient survival was 97% and corresponding graft survival, 66%. Allograft survival was inferior when acute antibody mediated rejection (ABMR) occurred (with 41%; without 70%, p = 0.01), however no differences were determined by hemolysis, time of onset, thrombi location or endothelial cell activation.
Conclusions:
Our results suggest that post-transplant TMA is a rare but severe condition, regardless of its clinical and histological presentation, mainly when associated to ABMR.
Insights
Post-transplant thrombotic microangiopathy (TMA) is rare but severe, impacting kidney transplant recipients. Early onset and systemic TMA are common, with infection and acute rejection as key triggers, affecting graft survival, especially with antibody-mediated rejection.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pathology
Background:
- Post-transplant thrombotic microangiopathy (TMA) presents with diverse clinical features.
- Understanding TMA's incidence and risk factors is crucial for managing kidney transplant outcomes.
Purpose of the Study:
- To analyze the clinical characteristics, precipitating factors, and outcomes of kidney transplant recipients with TMA.
- To identify factors influencing patient and graft survival in post-transplant TMA.
Main Methods:
- Retrospective study of 89 kidney transplant recipients diagnosed with TMA.
- Characterization of TMA based on biopsy findings (glomerular/arteriolar thrombi).
- Analysis of clinical data including onset timing, systemic involvement, triggers, and survival rates.
Main Results:
- The cumulative incidence of post-transplant TMA was 0.93%, with early onset in 51% and systemic TMA in 25% of patients.
- Infections (54%) and acute rejection (34%) were the most frequent triggers.
- One-year graft survival was 66%, significantly lower when associated with acute antibody-mediated rejection (ABMR) (41% vs. 70%).
Conclusions:
- Post-transplant TMA is a rare but serious complication following kidney transplantation.
- Graft survival is significantly impaired by concurrent acute antibody-mediated rejection.
- Clinical and histological presentation does not uniformly predict outcomes, highlighting the severity of TMA.
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