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Thrombotic microangiopathy transplant

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https://www.readbyqxmd.com/read/29198692/successful-recombinant-thrombomodulin-treatment-for-thrombotic-microangiopathy-after-liver-transplantation-a-case-report
#1
T Motomura, T Yoshizumi, M Ohira, Y Mano, T Toshima, S Itoh, N Harada, N Harimoto, T Ikegami, Y Soejima, Y Maehara
Transplant-associated thrombotic microangiopathy (TA-TMA) is a rare but severe complication after liver transplantation. In contrast to other thrombotic microangiopathies, treatment for TA-TMA has yet to be clarified. A 52-year-old male patient with liver cirrhosis due to hepatitis C underwent split liver transplantation from a deceased donor. His clinical course was without complication until 4 days after transplantation, when he experienced impaired consciousness, hemolytic anemia with fragmented erythrocytes, and marked thrombocytopenia...
December 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29157988/de-novo-thrombotic-microangiopathy-after-kidney-transplantation
#2
REVIEW
Neetika Garg, Helmut G Rennke, Martha Pavlakis, Kambiz Zandi-Nejad
Thrombotic microangiopathy (TMA) is a serious complication of transplantation that adversely affects kidney transplant recipient and allograft survival. Post-transplant TMA is usually classified into two categories: 1) recurrent TMA and 2) de novo TMA. Atypical hemolytic uremic syndrome (aHUS) resulting from dysregulation and over-activation of the alternate complement pathway is a rare disease but the most common diagnosis associated with recurrence in the allografts. De novo TMA, on the other hand, represents an overwhelming majority of the cases of post-transplant TMA and is a substantially more heterogeneous entity than recurrent aHUS...
November 4, 2017: Transplantation Reviews
https://www.readbyqxmd.com/read/29155318/kidney-pathology-after-hematologic-cell-transplantation-a-single-center-observation-study-of-indication-biopsies-and-autopsies
#3
Michael Girsberger, Jörg P Halter, Helmut Hopfer, Michael Dickenmann, Thomas Menter
Hematopoietic cell transplantation (HCT) is an increasingly used treatment for hematologic malignancies as well as for non-malignant diseases. Kidney impairment remains an important early and late posttransplant complication. Numerous histopathologic changes have been reported but the pathophysiology is still incompletely understood. Furthermore, correlations between clinical findings and morphologic changes are not well studied. Between 2000 and 2016, 17 patients after allogeneic (n=12) or autologous (n=5) HCT underwent kidney biopsy for either proteinuria or deterioration of kidney function at our center...
November 16, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/29136640/long-term-outcomes-of-the-atypical-hemolytic-uremic-syndrome-after-kidney-transplantation-treated-with-eculizumab-as-first-choice
#4
Luis Gustavo Modelli de Andrade, Mariana Moraes Contti, Hong Si Nga, Ariane Moyses Bravin, Henrique Mochida Takase, Rosa Marlene Viero, Trycia Nunes da Silva, Kelem De Nardi Chagas, Lilian Monteiro Pereira Palma
INTRODUCTION: The treatment of choice for Atypical Hemolytic Uremic Syndrome (aHUS) is the monoclonal antibody eculizumab. The objective of this study was to assess the efficacy and safety of eculizumab in a cohort of kidney transplant patients suffering from aHUS. METHODS: Description of the prospective cohort of all the patients primarily treated with eculizumab after transplantation and divided into the therapeutic (onset of aHUS after transplantation) and prophylactic use (patients with previous diagnosis of aHUS undergoing kidney transplantation)...
2017: PloS One
https://www.readbyqxmd.com/read/29114931/thrombotic-microangiopathy-with-concomitant-gi-agvhd-after-allogeneic-hematopoietic-stem-cell-transplantation-risk-factors-and-outcome
#5
Xiao-Hui Zhang, Xiao Liu, Qin-Ming Wang, Yun He, Xiao-Lu Zhu, Jia-Min Zhang, Wei Han, Huan Chen, Yu-Hong Chen, Feng-Rong Wang, Jing-Zhi Wang, Yuan-Yuan Zhang, Xiao-Dong Mo, Yao Chen, Yu Wang, Hai-Xia Fu, Ying-Jun Chang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Jun Huang
OBJECTIVES: To explore the possible risk factors for the occurrence and mortality of TMA with concomitant aGVHD and to investigate outcomes and treatments of this disorder after allo-HSCT. METHODS: 50 cases diagnosed with TMA with concomitant aGVHD and 150 controls were identified from a cohort composed of 3 992 patients who underwent allo-HSCT from 2008 to 2016. RESULTS: Grade III-IV aGVHD (p=0.000), acute kidney injury (AKI) (p=0.033) and hypertension (p=0...
November 7, 2017: European Journal of Haematology
https://www.readbyqxmd.com/read/29108509/smoking-history-is-associated-with-adverse-outcomes-for-kidney-allograft-recipients
#6
Holly Gillott, Francesca Jackson Spence, Sanna Tahir, Jemma Mytton, Felicity Evison, Jay Nath, Adnan Sharif
OBJECTIVES: How smoking history affects kidney allograft outcomes is unclear in the contemporary era of immunosuppression. Here, we examined a broad range of outcomes after kidney transplant, stratifying patients by smoking status documented at time of transplant, in a well-characterized clinical cohort. MATERIALS AND METHODS: This retrospective single-center analysis (2007-2015) included 744 kidney allograft recipients who had documentation of smoking exposure (median follow-up 1327 days posttransplant)...
October 31, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/29095297/everolimus-for-pediatric-patients-with-acute-graft-versus-host-disease-after-hematopoietic-stem-cell-transplantation-a-pilot-study
#7
Yu-Hua Chao, Yin-Chen Chang, Han-Ping Wu, Ching-Tien Peng, Te-Fu Weng, Kang-Hsi Wu
Acute graft-versus-host disease (aGVHD) is a significant cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Due to the poor prognosis for patients not responding to first-line steroids treatment, improvements in aGVHD therapy are needed. Everolimus is a promising candidate that combines immunosuppressive properties with anti-neoplastic effects. Here, we retrospectively reviewed the efficacy of everolimus with steroids as primary treatment in 13 patients with grade II to grade IV aGVHD after HSCT...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29076142/donor-derived-cd19-targeted-t-cell-infusion-induces-minimal-residual-disease-negative-remission-in-relapsed-b-cell-acute-lymphoblastic-leukaemia-with-no-response-to-donor-lymphocyte-infusions-after-haploidentical-haematopoietic-stem-cell-transplantation
#8
Yuhong Chen, Yifei Cheng, Pan Suo, Chenhua Yan, Yu Wang, Yao Chen, Wei Han, Lanping Xu, Xiaohui Zhang, Kaiyan Liu, Lungji Chang, Lei Xiao, Xiaojun Huang
Relapse is a common cause of failure in patients with B-cell acute lymphoblastic leukaemia (B-ALL) after haploidentical haematopoietic stem cell transplantation (haplo-HSCT), and non-responders to donor lymphoblastic infusion after HSCT have a very poor prognosis. Although donor-derived CD19-directed chimeric antigen receptor-modified (CAR) T cells can potentially cure leukaemia, their effectiveness and safety have not been confirmed in relapsed B-ALL cases after haplo-HSCT. Between January 2015 and January 2017, two and four patients each received one and two infusions of CAR T cells from haplo-HSCT donors...
October 26, 2017: British Journal of Haematology
https://www.readbyqxmd.com/read/29027535/transplant-glomerulopathy
#9
REVIEW
Edward J Filippone, Peter A McCue, John L Farber
In the renal allograft, transplant glomerulopathy represents a morphologic lesion and not a specific diagnosis. The hallmark pathologic feature is glomerular basement membrane reduplication by light microscopy or electron microscopy in the absence of immune complex deposits. Transplant glomerulopathy results from chronic, recurring endothelial cell injury that can be mediated by HLA alloantibodies (donor-specific antibodies), various autoantibodies, cell-mediated immune injury, thrombotic microangiopathy, or chronic hepatitis C...
October 13, 2017: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
https://www.readbyqxmd.com/read/29025381/adenovirus-infection-as-a-cause-of-fever-of-unknown-origin-and-allograft-dysfunction-in-a-kidney-transplant-recipient
#10
Michelle Saliba, Hala Kfoury Assouf, Souodod Abbas, Pierre Abi Hanna, Gaby Kamel, Antoine Barbari
With the recent introduction of more potent modern immunosuppressive regimens in solid-organ transplant, new types of viral infections such as adenovirus are emerging as a potential cause for graft dysfunction and loss. We report a case of 41-year-old male patient with end-stage renal disease from recurrent kidney stones who underwent kidney transplant from a deceased 12-year-old female donor. He developed adenoviral infection with acute cystitis, microscopic hematuria, and necrotizing interstitial nephritis associated with graft dysfunction within the first month of the postoperative period...
October 12, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28993886/thrombotic-microangiopathy-following-haematopoietic-stem-cell-transplant
#11
Eleanor G Seaby, Rodney D Gilbert
Thrombotic microangiopathy is a potentially lethal complication of haematopoietic stem cell (bone marrow) transplantation. The pathophysiology is incompletely understood, although endothelial damage appears to be central. Platelet activation, neutrophil extracellular traps and complement activation appear to play key roles. Diagnosis may be difficult and universally accepted diagnostic criteria are not available. Treatment remains controversial. In some cases, withdrawal of calcineurin inhibitors is adequate...
October 9, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28991129/a-heterozygous-cfhr3-cfhr1-gene-deletion-in-a-pediatric-patient-with-transplant-associated-thrombotic-microangiopathy-who-was-treated-with-eculizumab
#12
Akifumi Nozawa, Michio Ozeki, Tomohiro Hori, Norio Kawamoto, Masahiro Hirayama, Eiichi Azuma, Toshiyuki Fukao
Complement system dysregulation, such as complement Factor H (CFH) autoantibodies and deletions in CFH-related (CFHR) genes 3 and 1, might cause transplant-associated thrombotic microangiopathy (TA-TMA). The use of eculizumab, a terminal complement inhibitor, could be a targeted therapy for TA-TMA. We report a 1-year-old girl who developed TA-TMA, just after autologous peripheral blood stem cell transplantation in neuroblastoma therapy. Eculizumab improved TA-TMA. Investigation for the complement alternative pathway showed a heterozygous CFHR3-CFHR1 gene deletion, which is involved in complement activation...
October 4, 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/28975130/multiple-myeloma-as-the-underlying-cause-of-thrombotic-microangiopathy-leading-to-acute-kidney-injury-revisiting-a-very-rare-entity
#13
Savneek Chugh, Asim Kichloo, Firas Jafri, Liga Yusvirazi, Robert Lerner
Thrombotic microangiopathy (TMA) describes a pathological process of microvascular thrombosis, consumptive thrombocytopenia, and microangiopathic hemolytic anemia, leading to end-organ ischemia and infarction, affecting particularly the kidney and brain. TMA is a pathological feature of a number of clinical disorders including thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and atypical hemolytic uremic syndrome. Rare but important, TMA may also occur in malignancy, connective tissue disease, malignant hypertension, and renal transplantation (rejection or drug toxicity)...
July 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28972944/delayed-development-of-hemolytic-anemia-with-fragmented-red-blood-cells-and-cardiac-and-renal-impairments-after-high-dose-chemotherapy-and-autologous-hematopoietic-stem-cell-transplantation-for-malignant-lymphoma
#14
Futoshi Iioka, Yusuke Toda, Yuya Nagai, Takashi Akasaka, Daiki Shimomura, Katsuyo Tsuda, Fumihiko Nakamura, Hitoshi Ohno
Among 42 consecutive patients with malignant lymphoma who underwent high-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (AHSCT), 5 developed hemolytic anemia with fragmented red blood cells (HA-FrRBCs) on days 87-125 (median 107) of AHSCT. Nadir Hb levels ranged between 5.0 and 6.4 g/dL with 2.2-5.6% FrRBCs. All patients developed grade ≥3 hypoxia and heart failure, and 4 developed grade ≥3 hypertension. The ejection fraction of the left ventricle assessed by echocardiography was significantly reduced in 3 patients...
October 4, 2017: Acta Haematologica
https://www.readbyqxmd.com/read/28967899/hematopoietic-stem-cell-transplant-associated-thrombotic-microangiopathy-current-paradigm-and-novel-therapies
#15
REVIEW
J Khosla, A C Yeh, T R Spitzer, B R Dey
Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (TA-TMA) remains a difficult complication to address due to its high mortality rate, lack of standard diagnostic criteria and limited therapeutic options. Underscoring this challenge is the complex pathophysiology involved and multiple contributing factors that converge on a final pathway involving widespread endothelial injury and complement activation. In addressing our current understanding of TA-TMA, we highlight the risk factors leading to endothelial damage and a pathophysiological cascade that ensues...
October 2, 2017: Bone Marrow Transplantation
https://www.readbyqxmd.com/read/28947259/-hemolytic-and-uremic-syndrome-and-related-thrombotic-microangiopathies-treatment-and-prognosis
#16
C Rafat, P Coppo, F Fakhouri, V Frémeaux-Bacchi, C Loirat, J Zuber, E Rondeau
Major achievements in the understanding of thrombotic microangiopathies (TMA) have not only resulted in a reclassification of TMA but most of all they have culminated in the design of new treatments and have enabled clinicians to better delineate their prognosis. Recent multicenter studies have improved our understanding of the prognosis of atypical hemolytic and uremic syndromes (aHUS). More specifically, they have highlighted the role of genetic testing on predicting the recurrence of aHUS, the risk of chronic kidney disease and the recurrence following kidney transplantation...
September 22, 2017: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/28946961/secondary-thrombotic-microangiopathy-and-eculizumab-a-reasonable-therapeutic-option
#17
Elena Román, Santiago Mendizábal, Isidro Jarque, Javier de la Rubia, Amparo Sempere, Enrique Morales, Manuel Praga, Ana Ávila, José Luis Górriz
Understanding the role of the complement system in the pathogenesis of atypical haemolytic uraemic syndrome and other thrombotic microangiopathies (TMA) has led to the use of anti-complement therapy with eculizumab in these diseases, in addition to its original use in patients with paroxysmal nocturnal haemoglobinuria andatypical haemolytic uraemic syndrome. Scientific evidence shows that both primary and secondary TMAs with underlying complement activation are closely related. For this reasons, control over the complement system is a therapeutic target...
September 2017: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
https://www.readbyqxmd.com/read/28940837/a-case-of-the-nephrotic-syndrome-in-bone-marrow-transplantation-recipient-histologically-showing-overlapped-glomerular-lesions-of-thrombotic-microangiopathy-and-membranous-nephropathy
#18
Naoko Masuzawa, Ayako Nishimura, Takashi Kitani, Keiichi Tamagaki, Mio Sugitani, Hisao Nagoshi, Junya Kuroda, Eiichi Konishi
Nephrotic syndrome (NS) rarely occurs in post-hematopoietic stem cell transplantation (HSCT) recipients but represents the renal manifestation of graft-versus-host disease (GVHD). Membranous nephropathy (MN) accounts for almost two thirds of post-HSCT NS and is caused by immune complex deposition. Renal thrombotic microangiopathy (TMA) without fulfillment of clinical criteria for TMA has been underreported because of reduced opportunity for histological examination. However, renal TMA has recently been reported in association with GVHD and humoral immunological reactions...
September 20, 2017: Pathology International
https://www.readbyqxmd.com/read/28940540/successful-kidney-transplantation-in-a-patient-with-congenital-thrombotic-thrombocytopenic-purpura-upshaw-schulman-syndrome
#19
Hasan Fattah, Dhiren Kumar, James N George, H Davis Massey, Anne L King, Kenneth D Friedman, Gaurav Gupta
BACKGROUND: Congenital thrombotic thrombocytopenic purpura (TTP) may not be recognized until organ failure related to the microvascular thrombosis occurs. Kidney failure may be the initial presenting clinical feature. Kidney transplantation has been contraindicated because of the assumption that the continuing microvascular thrombosis will cause inevitable graft failure. CASE REPORT: We report a 48-year-old nulliparous woman who presented with end-stage kidney disease that was attributed to hypertension...
September 20, 2017: Transfusion
https://www.readbyqxmd.com/read/28890263/-secondary-thrombotic-microangiopathies
#20
P Coppo
Thrombotic microangiopathies (TMA) are termed secondary when associated to a specific context favouring their occurrence. They encompass mainly TMA associated with pregnancy, allogeneic hematopoietic stem cell transplantation, cancer, drugs, or HIV infection. Secondary TMA represent a heterogeneous group of diseases which clinical presentation largely depends on the associated context. It is therefore mandatory to recognize these conditions since they have a significant impact in TMA management and prognosis...
November 2017: La Revue de Médecine Interne
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