Subscribe to RSS
DOI: 10.1055/a-1941-9839
De-novo-thrombotische Mikroangiopathie (TMA) nach inkompatibler AB0-Nierentransplantation
De Novo Thombotic Microangiopathy (TMA) after Incompatible AB0 Renal Transplantation
Zusammenfassung
Anamnese Wir berichten über einen 57-jährigen Patienten, der in unserer Klinik zur geplanten AB0-inkompatiblen Lebendnierentransplantation aufgenommen wurde.
Untersuchungen und Diagnose An Tag 3 post operationem bildeten sich laborchemisch eindeutige Hinweise für eine Denovo-TMA aus. Die renale Entgiftung stagnierte bei initialem regelrechtem Verlauf.
Therapie und Verlauf Durch den Einsatz von Eculizumab 900 mg an d3 und d10 post operationem konnten wir die TMA mit einem anhaltenden Erfolg unterbinden.
Folgerung Zu diskutieren ist, ob ein frühzeitiger Einsatz von Eculizumab bei V. a. De-novo-TMA ein sicherer Weg ist, eine Transplantatdysfunktion zu unterbinden und somit die in der Literatur beschriebene schlechte Prognose für Transplantat und Empfänger zu verbessern.
Abstract
History We report a 57-year-old patient admitted to our hospital for planned AB0-incompatible living kidney transplantation.
Findings and Diagnosis On day 3 post operationem, clear laboratory evidence of de novo TMA developed. Renal detoxification stagnated with initial regular course.
Therapy and Course By using eculizumab 900 mg on d3 and d10 post operationem, we were able to suppress TMA with a sustained success.
Conclusion It has to be discussed whether an early use of eculizumab in cases of suspected de novo TMA is a safe way to prevent graft dysfunction and thus to improve the poor prognosis for graft and recipient described in the literature.
Publication History
Article published online:
16 November 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Tasaki M, Saito K, Nakagawa Y. et al. Analysis of the prevalence of systemic de novo thrombotic microangiopathy after ABO-incompatible kidney transplantation and the associated risk factors. Int J Urol 2019; 26: 1128-1137 DOI: 10.1111/iju.14118.
- 2 Reynolds JC, Agodoa LY, Yuan CM. et al. Thrombotic microangiopathy after renal transplantation in the United States. Am J Kidney Dis 2003; 42: 1058-1068
- 3 Abbas F, El Kossi M, Kim JJ. et al. Thrombotic microangiopathy after renal transplantation: Current insights in de novo and recurrent disease. World J Transplant 2018; 8: 122-141 DOI: 10.5500/wjt.v8.i5.122.
- 4 Nava F, Cappelli G, Mori G. et al. Everolimus, cyclosporine, and thrombotic microangiopathy: clinical role and preventive tools in renal transplantation. Transplant Proc 2014; 46: 2263-2268
- 5 Schwimmer J, Nadasdy TA, Spitalnik PF. et al. De novo thrombotic microangiopathy in renal transplant recipients: a comparison of hemolytic uremic syndrome with localized renal thrombotic microangiopathy. Am J Kidney Dis 2003; 41: 471-479
- 6 Cortina G, Trojer R, Waldegger S. et al. De novo tacrolimus-induced thrombotic microangiopathy in the early stage after renal transplantation successfully treated with conversion everolimus. Pediatr Nephrol 2015; 30: 693-697 PMID: 25577332 DOI: 10.1007/s00467-014-3036-8.
- 7 Nwaba A, MacQuillan G, Adams LA. et al. Tacrolimus-induced thrombotic microangiopathy in orthotopic liver transplant patients: case series of four patients. Intern Med J 2013; 43: 328-333 PMID:23441660 DOI: 10.1111/imj.12048.
- 8 Cicora F, Paz M, Mos F. et al. Use of belatacept as alternative immunosuppression in three renal transplant patients with de novo drug-induced thrombotic microangiopathy. Case Rep Med 2013; 2013: 260254 PMID:24198835 DOI: 10.1155/2013/260254.
- 9 George JN, Nester CM. Syndromes of thrombotic microangiopathy. N Engl J Med 2014; 371: 654-666
- 10 Scully M, Cataland S, Coppo P. et al. International Working Group for Thrombotic Thrombocytopenic Purpura: Consensus on the standardization of terminology in thrombotic thrombocytopenic purpura and related thrombotic microangiopathies. J Thromb Haemost 2017; 15: 312-322
- 11 Thurman JM, Nester CM. All things complement. Clin J Am Soc Nephrol 2016; 11: 1856-1866
- 12 Brocklebank V, Wood KM, Kavanagh D. Thrombotic Microangiopathy and the Kidney. CJASN 2018; 13: 300-317 DOI: 10.2215/CJN.00620117.