Follow-up of kidney graft recipients with cyclosporine-associated hemolytic-uremic syndrome and thrombotic microangiopathy.

Abstract

The study was based on 462 patients who underwent kidney transplantation from 1986 through 2004. Cyclosporine (CsA)-related thrombotic microangiopathy (TMA) was observed in 15 (3.3%) patients. The donor ages ranged from 9 to 51 years and cold ischemia times from 12 to 31 hours. Hemolytic-uremic syndrome (HUS) developed 2 weeks after transplantation in 14 patients and later in 1 subject. Histopathologic examination demonstrated glomerular-type TMA in 3 patients, a mixed type (glomerular and vascular) in 11 patients, and a nonspecific mesangial widening with tubulointerstitial lesions in 1 patient. Follow-up biopsies revealed resolution of TMA in 4 patients and chronic vascular TMA in 1 patient. Six patients with mixed-type TMA needed transient hemodialysis. No patient with the glomerular-type TMA needed dialysis (P = .103), and 14 of 15 had good resolution of graft function after CsA dose reduction or temporary discontinuation or continuation of optimal dose. Only 1 graft with mixed-type TMA was lost due to irreversible HUS. The mean glomerular filtration rate (GFR), predicted by the Nankivell equation, was 76 +/- 13 mL/min and 80 +/- 27 mL/min at 1 month after discharge for glomerular- and mixed-type TMA, respectively (P > .05). GFRs 1 year after HUS were 82 +/- 12 and 87 +/- 21 mL/min for the glomerular and the mixed types, respectively (P > .05). We concluded that the mixed-type TMA was associated with a more severe early clinical course than the glomerular-type TMA. The 1-year prognosis was good in the majority of patients, with no significant differences between those with the glomerular- and mixed-type TMA.

• Authors: A Bren, J Pajek, K Grego, J Buturovic, R Ponikvar, J Lindic, B Knap, A Vizjak, D Ferluga, A Kandus
• Journal: Transplantation proceedings (Transplant Proc) Vol. 37 Issue 4 Pg. 1889-91 (May 2005) ISSN: 0041-1345 [Print] United States
• PMID: 15919494 (Publication Type: Journal Article)

Chemical References

• Immunosuppressive Agents
• Isoantibodies
• Cyclosporine
• L-Lactate Dehydrogenase

Topics

• Adolescent
• Adult
• Anemia (epidemiology)
• Child
• Cyclosporine (adverse effects, pharmacokinetics)
• Female
• Hemolytic-Uremic Syndrome (chemically induced)
• Humans
• Immunosuppressive Agents (adverse effects, pharmacokinetics)
• Isoantibodies (blood)
• Kidney Failure, Chronic (surgery)
• Kidney Glomerulus (blood supply, pathology)
• Kidney Transplantation (adverse effects, immunology, pathology)
• L-Lactate Dehydrogenase (blood)
• Male
• Middle Aged
• Postoperative Complications (chemically induced, epidemiology)
• Retrospective Studies
• Thrombosis (chemically induced, pathology)
• Tissue Donors