Use of Eculizumab in Transplant-Associated Thrombotic Microangiopathy in a Patient With Polycystic Kidney Disease Immediately Post–Kidney Transplant: A Case Report

Godara, Amandeep; Migliozzi, Daniel R.; Pilichowska, Monika; Goyal, Nitender; Varga, Cindy; Gordon, Craig E.

doi:10.1016/j.xkme.2020.06.007

Cited by 6 publications

(3 citation statements)

References 28 publications

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“…Single case report has described the successful treatment of TMA after kidney transplantation with eculizumab. 78 However, there is a clear need for RCT that may have a pragmatic trial design to facilitate recruitment.…”

Section: Clinical Experience With Eculizumab In De Novo Thrombotic Mi...mentioning

confidence: 99%

“…However, it is important to emphasize the lack of RCT in this field and recommendations depend on expert opinions and case reports. Single case report has described the successful treatment of TMA after kidney transplantation with eculizumab 78 . However, there is a clear need for RCT that may have a pragmatic trial design to facilitate recruitment.…”

Section: Clinical Experience With Eculizumab In De Novo Thrombotic Mi...mentioning

confidence: 99%

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The role of anticomplement therapy in the management of the kidney allograft

Kanbay,

Copur,

Yilmaz

et al. 2024

Clinical Transplantation

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As the number of patients living with kidney failure grows, the need also grows for kidney transplantation, the gold standard kidney replacement therapy that provides a survival advantage. This may result in an increased rate of transplantation from HLA‐mismatched donors that increases the rate of antibody‐mediated rejection (AMR), which already is the leading cause of allograft failure. Plasmapheresis, intravenous immunoglobulin therapy, anti‐CD20 therapies (i.e., rituximab), bortezomib and splenectomy have been used over the years to treat AMR as well as to prevent AMR in high‐risk sensitized kidney transplant recipients. Eculizumab and ravulizumab are monoclonal antibodies targeting the C5 protein of the complement pathway and part of the expanding field of anticomplement therapies, which is not limited to kidney transplant recipients, and also includes complement‐mediated microangiopathic hemolytic anemia, paroxysmal nocturnal hemoglobinuria, and ANCA‐vasculitis. In this narrative review, we summarize the current knowledge concerning the pathophysiological background and use of anti‐C5 strategies (eculizumab and ravulizumab) and C1‐esterase inhibitor in AMR, either to prevent AMR in high‐risk desensitized patients or to treat AMR as first‐line or rescue therapy and also to treat de novo thrombotic microangiopathy in kidney transplant recipients.

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Section: Clinical Experience With Eculizumab In De Novo Thrombotic Mi...mentioning

confidence: 99%

Section: Clinical Experience With Eculizumab In De Novo Thrombotic Mi...mentioning

confidence: 99%

The role of anticomplement therapy in the management of the kidney allograft

Kanbay,

Copur,

Yilmaz

et al. 2024

Clinical Transplantation

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show abstract

“…4,9 TA-TMA is most commonly associated with allogeneic HSCTs, but it has also been reported after autologous stem cell transplants 10 and solid organ transplants. [11][12][13] Children receiving tandem autologous stem cell transplants for neuroblastoma seem to be at high risk of developing TA-TMA. 10 The clinical manifestation can range from mild anemia and thrombocytopenia to severe MODS and death.…”

Section: Introductionmentioning

confidence: 99%

Thrombotic Microangiopathy After Hematopoietic Stem Cell and Solid Organ Transplantation: A Review for Intensive Care Physicians

Nusrat,

Davis,

MacDougall

et al. 2023

J Intensive Care Med

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Intensive care physicians may assume the primary care of patients with transplant-associated thrombotic microangiopathy (TA-TMA), an uncommon but potentially critical complication of hematopoietic stem cell transplants (HSCTs) and solid organ transplants. TA-TMA can have a dramatic presentation with multiple organ dysfunction syndrome (MODS) associated with high morbidity and mortality. The typical presenting clinical features are hemolytic anemia, thrombocytopenia, refractory hypertension, proteinuria and worsening renal failure. Intestinal involvement, with abdominal pain, nausea and vomiting, gastrointestinal bleeding, and ascites are also common. Cardiopulmonary involvement may develop from various causes including pulmonary arteriolar hypertension, pleural and pericardial effusions, and diffuse alveolar hemorrhage. Due to other often concurrent complications after HSCT, early diagnosis and effective management of TA-TMA may be challenging. Close collaboration between ICU and transplant physicians, along with other relevant specialists, is needed to best manage these patients. There are currently no approved therapies for the treatment of TA-TMA. Plasma exchange and rituximab are not recommended unless circulating factor H (CFH) antibodies or thrombotic thrombocytopenic purpura (TTP; ADAMTS activity < 10%) are diagnosed or highly suspected. The role of the complement pathway activation in the pathophysiology of TA-TMA has led to the successful use of targeted complement inhibitors, such as eculizumab. However, the relatively larger studies using eculizumab have been mostly conducted in the pediatric population with limited data on the adult population. This review is focused on the role of intensive care physicians to emphasize the clinical approach to patients with suspected TA-TMA and to discuss diagnosis and treatment strategies.

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Tacrolimus

2020

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Use of Eculizumab in Transplant-Associated Thrombotic Microangiopathy in a Patient With Polycystic Kidney Disease Immediately Post–Kidney Transplant: A Case Report

Cited by 6 publications

References 28 publications

The role of anticomplement therapy in the management of the kidney allograft

The role of anticomplement therapy in the management of the kidney allograft

Thrombotic Microangiopathy After Hematopoietic Stem Cell and Solid Organ Transplantation: A Review for Intensive Care Physicians

Tacrolimus

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