The importance of genetic mutation screening to determine retransplantation following failed kidney allograft from recurrent atypical haemolytic ureamic syndrome

Chua, Samantha; Wong, Germaine; Lim, Wai H.

doi:10.1136/bcr-2013-202875

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…25 And like other retrospective studies we had no information about whether the TMA was systemic or localized 6, 26 which has implication in determining the short term survival, but long term survival is similar in both forms 27,28 Another limitation regarding the recurrent TMA cases, performing genetic testing at time of diagnosis of TMA would be fundamental for assessing the possible outcome. 29 Genetic testing also has therapeutic benefit because unlike de novo TMA which has limited treatment options, recurrent TMA has an effective therapy by blockade of c5-9 through Eculizumab. 30 Still this study is considered the first study in Kurdistan region to shed the light on the topic of TMA after kidney transplantation and describe clinical and pathological features of biopsy proven TMA…”

Section: Resultsmentioning

confidence: 99%

Thrombotic microangiopathy after kidney transplantion

Tahseen,

Nouruldin

2023

Adv.med.j.

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Background and objectives: Thrombotic microangiopathy after kidney transplantation is rare but serious complication. The purpose of this study is to describe the cases of thrombotic microangiopathy after kidney transplantation. Patients and Methods: This retrospective study used the reports of all kidney transplant biopsies that were done in Kurdistan region from January 2017 to April 2022. The biopsy reports with diagnosis of Thrombotic microangiopathy were extracted from this total number and the patients, and pathological data included in the reports were recorded. Results: The total number of 1635 graft biopsies, of which 82 (5.01%) were found to have Thrombotic microangiopathy features. The mean age of studied patients with Thrombotic microangiopathy was (38.2 years) and male to female ratio as 2.3:1. We found 67.1% of cases of Thrombotic microangiopathy were associated with calcineurin inhibitor toxicity, 35.4% with rejection, 15.9% were recurrent thrombotic microangiopathy, and 40.2% were associated with other miscellaneous causes. Conclusions: Thrombotic microangiopathy after kidney transplantation is rare but debilitating complication. The cause is multifactorial in most cases in the light of coexistence of multiple risk factors in the kidney transplant recipients. Further studies are required to disentangle these overlapping risk factors. And allow for better prevention and treatment of this condition.

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Section: Resultsmentioning

confidence: 99%

Thrombotic microangiopathy after kidney transplantion

Tahseen,

Nouruldin

2023

Adv.med.j.

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“…In the case of aHUS, less aggressive genotype mutations may be amenable to retransplantation with a low risk of recurrence. 68 The availability of terminal complement pathway inhibiting drugs has considerably improved access to retransplantation in those with aHUS from genetic mutations. 66,69,70 The FSGS recurrence rate varies widely (8%-86%).…”

Section: Retransplantation After Primary Disease Recurrencementioning

confidence: 99%

How to Deal With Kidney Retransplantation—Second, Third, Fourth, and Beyond

Sageshima¹,

Chandar²,

Chen

et al. 2021

Transplantation

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Kidney transplantation is the best health option for patients with end-stage kidney disease. Ideally, a kidney transplant would last for the lifetime of each recipient. However, depending on the age of the recipient and details of the kidney transplant, there may be a need for a second, third, fourth, or even more kidney transplants. In this overview, the outcome of multiple kidney transplants for an individual is presented. Key issues include surgical approach and immunologic concerns. Included in the surgical approach is an analysis of transplant nephrectomy, with indications, timing, and immunologic impact. Allograft thrombosis, whether related to donor or recipient factors merits investigation to prevent it from happening again. Other posttransplant events such as rejection, viral illness (polyomavirus hominis type I), recurrent disease (focal segmental glomerulosclerosis), and posttransplant lymphoproliferative disease may lead to the need for retransplantation. The pediatric recipient is especially likely to need a subsequent kidney transplant. Finally, noncompliance/nonadherence can affect both adults and children. Innovative approaches may reduce the need for retransplantation in the future.

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“…Not all of the genetic mutations share the same magnitude of risk on allograft survival. Despite the fact that genetic screening is difficult and complex and the spectrum of gene mutation is a continuously expanding field[ 102 ], performing such studies is fundamental to determining the possible outcome of the kidney transplant in the set of aHUS recurrence[ 128 ].…”

Section: Pathophysiology Of Tma Recurrencementioning

confidence: 99%

Thrombotic microangiopathy after renal transplantation: Current insights inde novoand recurrent disease

Abbas¹,

Kossi

Kim

et al. 2018

WJT

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Thrombotic microangiopathy (TMA) is one of the most devastating sequalae of kidney transplantation. A number of published articles have covered either de novo or recurrent TMA in an isolated manner. We have, hereby, in this article endeavored to address both types of TMA in a comparative mode. We appreciate that de novo TMA is more common and its prognosis is poorer than recurrent TMA; the latter has a genetic background, with mutations that impact disease behavior and, consequently, allograft and patient survival. Post-transplant TMA can occur as a recurrence of the disease involving the native kidney or as de novo disease with no evidence of previous involvement before transplant. While atypical hemolytic uremic syndrome is a rare disease that results from complement dysregulation with alternative pathway overactivity, de novo TMA is a heterogenous set of various etiologies and constitutes the vast majority of post-transplant TMA cases. Management of both diseases varies from simple maneuvers, e.g., plasmapheresis, drug withdrawal or dose modification, to lifelong complement blockade, which is rather costly. Careful donor selection and proper recipient preparation, including complete genetic screening, would be a pragmatic approach. Novel therapies, e.g., purified products of the deficient genes, though promising in theory, are not yet of proven value.

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The importance of genetic mutation screening to determine retransplantation following failed kidney allograft from recurrent atypical haemolytic ureamic syndrome

Cited by 5 publications

References 22 publications

Thrombotic microangiopathy after kidney transplantion

Thrombotic microangiopathy after kidney transplantion

How to Deal With Kidney Retransplantation—Second, Third, Fourth, and Beyond

Thrombotic microangiopathy after renal transplantation: Current insights inde novoand recurrent disease

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