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Thrombotic microangiopathies after kidney transplantation in modern era: nosology based on chronology

Florent Von Tokarski1, Alexandre Fillon1, Valentin Maisons1

  • 1Service de Néphrologie-HTA, Dialyses, Transplantation Rénale, Hôpital Bretonneau Et Hôpital Clôcheville, CHU Tours, 2 Bd Tonnellé, 37044, Tours, Tours Cedex, France.

BMC Nephrology
|September 20, 2023
PubMed
Abstract

Insights

Thrombotic microangiopathies (TMAs) in kidney transplant recipients are often linked to antibody-mediated rejection and infections. Understanding TMA timing is key to distinct prognoses and management strategies.

Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Pathology

Background:

  • Thrombotic microangiopathies (TMAs) represent a rare but severe complication in kidney transplant recipients (KTR).
  • TMAs can significantly impact graft survival and patient outcomes.

Purpose of the Study:

  • To analyze the epidemiology of adjudicated TMAs in kidney transplant recipients.
  • To identify the incidence, triggers, and outcomes associated with different TMA timings.

Main Methods:

  • Analysis of adjudicated TMA cases in consecutive KTR from 2009-2021.
  • Categorization of TMAs based on timing: early, unexpected, and graft-failure associated.

Main Results:

  • TMA occurred in 4.7% of KTR, with early TMA (1.5%) linked to rejection or infection and 100% graft survival.
  • Unexpected TMA (1.5/1000 patient-years) had varied triggers including infections and chronic active ABMR, with 81% graft survival.
  • Graft-failure associated TMA (2.2% of graft losses) occurred later, often linked to chronic active ABMR, infections, or cancer, with a 27% recurrence rate.

Conclusions:

  • TMAs in KTR are primarily driven by antibody-mediated rejection (ABMR) and infections, often with combined causes.
  • A nosology based on TMA timing reveals distinct patterns in incidence, etiology, and prognosis.
  • Heterogeneous management strategies highlight the need for tailored approaches based on TMA classification.
Keywords:
Hemolytic uremic syndromeInfectionKidney transplantationMalignant hypertensionOutcomes

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