Patients with early thrombotic microangiopathy may have reduced allograft survival
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Key takeaways:
- Overall, 55 patients were diagnosed with thrombotic microangiopathy.
- Survival rates were lower in patients with thrombotic microangiopathy vs. controls.
PHILADELPHIA — Patients with early thrombotic microangiopathy may have reduced allograft function and decreased allograft and patient survival with long-term follow-up.
“There are specific risk factors that can lead to [thrombotic microangiopathy (TMA)] in transplant, including ischemia reperfusion injury, recurrence of disease, transplant medications [and rejection and infection-related causes],” Hay M. Me, MBBS, of the division of transplant nephrology at Mayo Clinic in Arizona, said at the American Transplant Congress. “However, there are limited literature about the outcomes of early TMA in transplantation.”
Researchers ran a retrospective study of 4,808 patients who had a kidney transplant from 2002 to 2023 to assess the outcomes of early thrombotic microangiopathy. Me and colleagues compared histologic progression, allograft and patient outcomes of early thrombotic microangiopathy (defined as less than 4 months post-transplant) with patients without thrombotic microangiopathy. Researchers used biopsies at 4 and 12 months to assess histologic progression.
Overall, 55 patients in the study group were diagnosed with thrombotic microangiopathy, according to the findings. The median onset was 9 days post-transplant with progressive glomerular scores and increased chronicity in biopsies at 4 and 12 months. Researchers found 13% of patients with thrombotic microangiopathy had antibody-mediated rejection. Genetic testing showed positive mutations or equivocal results in a significant portion of patients.
Treatment included eculizumab, plasmapheresis and switching from calcineurin inhibitors to mTOR inhibitors or belatacept. However, Me and colleagues saw lower median GFR, and survival rates were lower in patients with thrombotic microangiopathy vs. without: 5 years (68% vs. 88%), and decreased graft survival rates at 1 year (84% vs. 97%) and 5 years (52% vs. 83%), respectively.
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Me H, et al. Poster 1080. Presented at: American Transplant Congress; June 1-5, 2024; Philadelphia.
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