Early Thrombotic Microangiopathy After ABO-Incompatible Living Donor Kidney Transplantation
Introduction: Although long-term graft survival is comparable with that of ABO-compatible (ABOc) renal transplantation, the risk of antibody-mediated rejection (ABMR) following ABO-incompatible (ABOi) transplantation is higher and can occur as an early thrombotic microangiopathy (TMA). Methods: We d...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
|
| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024924034776 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849335863993958400 |
|---|---|
| author | Dominique Bertrand Arnaud Del Bello Rebecca Sberro Soussan Sophie Caillard Guillaume Claisse Lionel Couzi Sophie Girerd Alexandre Hertig Yannick Le Meur Vincent Pernin Coralie Poulain Cédric Rafat Marie Matignon Arnaud Buteux Arnaud François Mathilde Lemoine Charlotte Laurent Nassim Kamar Tristan de Nattes Dominique Guerrot |
| author_facet | Dominique Bertrand Arnaud Del Bello Rebecca Sberro Soussan Sophie Caillard Guillaume Claisse Lionel Couzi Sophie Girerd Alexandre Hertig Yannick Le Meur Vincent Pernin Coralie Poulain Cédric Rafat Marie Matignon Arnaud Buteux Arnaud François Mathilde Lemoine Charlotte Laurent Nassim Kamar Tristan de Nattes Dominique Guerrot |
| author_sort | Dominique Bertrand |
| collection | DOAJ |
| description | Introduction: Although long-term graft survival is comparable with that of ABO-compatible (ABOc) renal transplantation, the risk of antibody-mediated rejection (ABMR) following ABO-incompatible (ABOi) transplantation is higher and can occur as an early thrombotic microangiopathy (TMA). Methods: We designed a retrospective multicenter study, including all patients who presented with a TMA (histological and/or biological) after an ABOi transplantation (< 1 month) and compared with matched controls who had a favorable initial course with a normal biopsy. Results: Between 2013 and 2022, 375 ABOi kidney transplants were performed and 23 patients (6.1%) developed TMA (median: 1 day, interquartile range [IQR]: 0–3 days). Twenty-one patients (91.3%) had biological TMA. Among 23 early graft biopsies, histological evidence of active TMA was found in 17 cases (80.9%). All patients received treatment: 20 of 23 received at least 1 session of plasmapheresis and 19 of 23 received at least 1 injection of eculizumab. Eight early graft losses (30.4%) occurred (median: 7 days, IQR: 3–16 days). IgG and IgM anti–blood group antibody (ABGA) levels (peak and last pregraft assay) were significantly higher in the TMA group (peak: P = 0.01 for IgG and P = 0.0006 for IgM; last assay before kidney transplantation [KT]: P < 0.0001 for IgG and P = 0.0003 for IgM). A level ≥ 1/8 for IgG and ≥ 1/4 or IgM before transplantation were significantly and independently predictive of the occurrence of TMA. No other predictive factors were found. Conclusion: TMA after ABOi transplantation is not a rare phenomenon and is associated with a poor prognosis in nonresponders-to-treatment patients. ABGA titer performed by hemagglutination is an imperfect marker of the occurrence of such a phenomenon. |
| format | Article |
| id | doaj-art-b8b8a5d892624a71ac8022e7baa7eca3 |
| institution | Kabale University |
| issn | 2468-0249 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-b8b8a5d892624a71ac8022e7baa7eca32025-08-20T03:45:08ZengElsevierKidney International Reports2468-02492025-03-0110382883710.1016/j.ekir.2024.12.031Early Thrombotic Microangiopathy After ABO-Incompatible Living Donor Kidney TransplantationDominique Bertrand0Arnaud Del Bello1Rebecca Sberro Soussan2Sophie Caillard3Guillaume Claisse4Lionel Couzi5Sophie Girerd6Alexandre Hertig7Yannick Le Meur8Vincent Pernin9Coralie Poulain10Cédric Rafat11Marie Matignon12Arnaud Buteux13Arnaud François14Mathilde Lemoine15Charlotte Laurent16Nassim Kamar17Tristan de Nattes18Dominique Guerrot19Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France; Correspondence: Dominique Bertrand, 1 rue de Germont, Rouen University Hospital, Rouen, France.Nephrology and Organ Transplantation Department, Rangueil Toulouse University Hospital, Toulouse, FranceNecker-Enfants Malades Institute, French National Institute of Health and Medical Research, Paris, FranceNephrology and Transplantation Department, Strasbourg University Hospital, Strasbourg, FranceNephrology, Dialysis and Renal Transplantation Department, Hôpital Nord, CHU de Saint-Etienne, Jean Monnet University, Université de Lyon, Saint-Etienne, FranceDepartment of Nephrology, Kidney Transplantation and Hemodialysis, Bordeaux University Hospital, Rouen, FranceDepartment of Nephrology, Kidney Transplantation and Hemodialysis, Nancy University Hospital, Rouen, FranceDepartment of Nephrology, Kidney Transplantation and Hemodialysis, Foch Hospital, Suresnes, FranceDepartment of Nephrology, Kidney Transplantation and Hemodialysis, Brest University Hospital, Rouen, FranceDepartment of Nephrology, Kidney Transplantation and Hemodialysis, Montpellier University Hospital, Rouen, FranceDepartment of Nephrology, Kidney Transplantation and Hemodialysis, Amiens University Hospital, Rouen, FranceSoins Intensifs de Néphrologie et Rein Aigu, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, FranceDepartment of Nephrology, Kidney Transplantation and Hemodialysis, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, FranceEFS Etablissement Français du Sang, Rouen University Hospital, Rouen, FranceService d'anatomopathologie, Rouen University Hospital, Rouen, FranceDepartment of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, FranceDepartment of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, FranceNephrology and Organ Transplantation Department, Rangueil Toulouse University Hospital, Toulouse, FranceDepartment of Nephrology, INSERM U1234, CHU Rouen, Nephrology Department, Universite Rouen Normandie, Rouen, FranceDepartment of Nephrology, INSERM U1096, CHU Rouen, Universite Rouen Normandie, Rouen, FranceIntroduction: Although long-term graft survival is comparable with that of ABO-compatible (ABOc) renal transplantation, the risk of antibody-mediated rejection (ABMR) following ABO-incompatible (ABOi) transplantation is higher and can occur as an early thrombotic microangiopathy (TMA). Methods: We designed a retrospective multicenter study, including all patients who presented with a TMA (histological and/or biological) after an ABOi transplantation (< 1 month) and compared with matched controls who had a favorable initial course with a normal biopsy. Results: Between 2013 and 2022, 375 ABOi kidney transplants were performed and 23 patients (6.1%) developed TMA (median: 1 day, interquartile range [IQR]: 0–3 days). Twenty-one patients (91.3%) had biological TMA. Among 23 early graft biopsies, histological evidence of active TMA was found in 17 cases (80.9%). All patients received treatment: 20 of 23 received at least 1 session of plasmapheresis and 19 of 23 received at least 1 injection of eculizumab. Eight early graft losses (30.4%) occurred (median: 7 days, IQR: 3–16 days). IgG and IgM anti–blood group antibody (ABGA) levels (peak and last pregraft assay) were significantly higher in the TMA group (peak: P = 0.01 for IgG and P = 0.0006 for IgM; last assay before kidney transplantation [KT]: P < 0.0001 for IgG and P = 0.0003 for IgM). A level ≥ 1/8 for IgG and ≥ 1/4 or IgM before transplantation were significantly and independently predictive of the occurrence of TMA. No other predictive factors were found. Conclusion: TMA after ABOi transplantation is not a rare phenomenon and is associated with a poor prognosis in nonresponders-to-treatment patients. ABGA titer performed by hemagglutination is an imperfect marker of the occurrence of such a phenomenon.http://www.sciencedirect.com/science/article/pii/S2468024924034776ABO-incompatibleantibody-mediated rejectioneculizumabkidney transplantationthrombotic microangiopathy |
| spellingShingle | Dominique Bertrand Arnaud Del Bello Rebecca Sberro Soussan Sophie Caillard Guillaume Claisse Lionel Couzi Sophie Girerd Alexandre Hertig Yannick Le Meur Vincent Pernin Coralie Poulain Cédric Rafat Marie Matignon Arnaud Buteux Arnaud François Mathilde Lemoine Charlotte Laurent Nassim Kamar Tristan de Nattes Dominique Guerrot Early Thrombotic Microangiopathy After ABO-Incompatible Living Donor Kidney Transplantation Kidney International Reports ABO-incompatible antibody-mediated rejection eculizumab kidney transplantation thrombotic microangiopathy |
| title | Early Thrombotic Microangiopathy After ABO-Incompatible Living Donor Kidney Transplantation |
| title_full | Early Thrombotic Microangiopathy After ABO-Incompatible Living Donor Kidney Transplantation |
| title_fullStr | Early Thrombotic Microangiopathy After ABO-Incompatible Living Donor Kidney Transplantation |
| title_full_unstemmed | Early Thrombotic Microangiopathy After ABO-Incompatible Living Donor Kidney Transplantation |
| title_short | Early Thrombotic Microangiopathy After ABO-Incompatible Living Donor Kidney Transplantation |
| title_sort | early thrombotic microangiopathy after abo incompatible living donor kidney transplantation |
| topic | ABO-incompatible antibody-mediated rejection eculizumab kidney transplantation thrombotic microangiopathy |
| url | http://www.sciencedirect.com/science/article/pii/S2468024924034776 |
| work_keys_str_mv | AT dominiquebertrand earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT arnauddelbello earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT rebeccasberrosoussan earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT sophiecaillard earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT guillaumeclaisse earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT lionelcouzi earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT sophiegirerd earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT alexandrehertig earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT yannicklemeur earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT vincentpernin earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT coraliepoulain earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT cedricrafat earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT mariematignon earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT arnaudbuteux earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT arnaudfrancois earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT mathildelemoine earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT charlottelaurent earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT nassimkamar earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT tristandenattes earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation AT dominiqueguerrot earlythromboticmicroangiopathyafteraboincompatiblelivingdonorkidneytransplantation |