Original contributions: Case reportsKidneyBelatacept and Eculizumab for Treatment of Calcineurin Inhibitor-induced Thrombotic Microangiopathy After Kidney Transplantation: Case Report
Section snippets
Case Report
A 22 year-old male presented with renal disease secondary to hemolytic uremic syndrome (HUS) associated with enteropathogenic Escherichia coli infection at age 2 years. He underwent living-related kidney transplantation at age 3 years, suffered graft loss at age 12 years, and subsequently underwent a second living-related kidney transplantation the following year. This allograft was lost to chronic antibody-mediated rejection at age 21 years. Both grafts were lost due to chronic allograft
Discussion
The case presented here represents the first description of the combined use of belatacept and eculizumab for CNI-induced TMA. TMA is a severe complication of renal allotransplantation, often occurring within the first 6 months after operation. Pathologically, TMA is marked by vascular damage within the arterioles and glomeruli with intraluminal thrombosis and arteriolar wall thickening.
TMA is categorized as de novo or recurrent after transplantation. De novo TMA is less common and is defined
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Cited by (13)
Renal Transplant Immunosuppression in Patients With Hemolytic Uremic Syndrome: Four Case Reports
2018, Transplantation ProceedingsCitation Excerpt :Although there are no clearly established guidelines in transplantation immunosuppression in patients with aHUS, the use of eculizumab pre- and post-transplantation is considered beneficial due to its mechanism of blocking the C5 fraction of the complement [16]. There are already some published cases [8,17,18] with a good evolution. In the available studies, a high percentage of re-transplantations is highlighted, possibly due to lower survival of the graft in these patients with a more potent induction because of the greater risk of associated rejection and some of them already hyperimmunized.
Clinical characteristics, treatments, and outcomes of interferon-beta-induced thrombotic microangiopathy: a literature-based retrospective analysis
2023, Therapeutic Advances in Neurological DisordersPost-transplant Intestinal Thrombotic Microangiopathy
2023, Digestive Diseases and SciencesEculizumab use in a tertiary care nephrology center: data from the Vienna TMA cohort
2022, Journal of Nephrology