UNFOLDING THE MYSTERY OF THROMBOTIC MICRO-ANGIOPATHY IN KIDNEY TRANSPLANTATION: ITS INCIDENCE, RISK FACTORS AND CLINICAL OUTCOMES THROUGH BIOPSY PRECISION

 

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UNFOLDING THE MYSTERY OF THROMBOTIC MICRO-ANGIOPATHY IN KIDNEY TRANSPLANTATION: ITS INCIDENCE, RISK FACTORS AND CLINICAL OUTCOMES THROUGH BIOPSY PRECISION

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Amber
Raza
Amber Raza dramber88@gmail.com Sindh Institute of Urology and Transplantation Nephrology Karachi Pakistan *
Tahir Aziz tahir_aziz61@yahoo.com Sindh Institute of Urology and Transplantation Nephrology Karachi Pakistan -
Muhammad Mubarak m.mubarak@siut.edu.pk Sindh Institute of Urology and Transplantation Histopathology Karachi Pakistan -
Rafia Rauf info@siut.org Sindh Institute of Urology and Transplantation Nephrology Karachi Pakistan -
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Thrombotic micro-angiopathy (TMA) is a rare yet challenging complication in kidney transplant recipients, having a strong impact on both patient and graft survival. Prevalence ranges from 0.8% to 14% in transplant recipients.

Our aim was to elucidate the incidence, risk factors and the impact of TMA on transplant outcome in our patient cohort.

A Single-center descriptive and retrospective study was conducted among renal transplant recipient’s patients from SIUT hospital transplant unit between 2011 and 2021.Cases with biopsy proven TMA in this period were studied. TMA was categorized into 1) CNI associated 2) Rejection associated 3) infection associated. 4) Others. Graft function  before and after treatment was analyzed.  

Out of 1885 renal transplant recipients 126 patients (6.68%) had biopsy proven thrombotic micro-angiopathy. The mean age of patients with allograft dysfunction was 28.21 ± 8.42 years with 100 males (79.4%) and 26 females (20.6%). At the time of diagnosis of TMA 58 patients (46%) had Deltacortil+ Azathioprine+ cyclosporine as immunosuppression of choice.  The causes of renal allograft dysfunction as found on microscopic examination of the renal biopsy specimens were CNI Induced TMA i.e., cyclosporine (67 patients=53.2%) and tacrolimus (31 patients=24.6%), Rejection associated TMA in 31 patients (24.6%) out of which 13 (10.3%) had cellular, 11 (8.7%) Antibody mediated rejection, 3 (2.4%) vascular and 2(1.6%) had mixed rejection respectively. Triggering infections contributing 27 patients (21.4%) with UTI in 18 patients (14.3%).  Majority of the patients had early onset of TMA (39 patients=31%) compared to 27 patients (21.4%) who had after more than 48 months. Mean Serum Creatinine at the time of diagnosis of TMA is 1.94±0.93, while serum creatinine at 3 months post TMA found to be 2.21±1.67 and at 6 months 2.16±1.62 and after 1 year was 2.37±1.95. 55 patients (43.7%) had complete recovery, 38 (30.2%) showed no response, 15 (11.9%) developed ESRD with mortality in 6 (4.8%) as an outcome 1 year post transplantation.

Thrombotic Micro-angiopathy occurring after transplant adversely affects graft function and a significant minority lose their graft in one year.

Kewords