42 Follow‐up of Kidney Graft Recipients with Cyclosporine Associated Hemolytic Uremic Syndrome and Thrombotic Microangiopathy

Abstract

The study was based on 462 patients who underwent kidney transplantation from 1986 through September 2003. Cyclosporine (Cs) related thrombotic microangiopathy (TMA) was found in 15 (3.3%) patients. Donors aged from 9 to 51 years. Cold ischemia time ranged from 12 to 31 hours. Hemolytic uremic syndrome (HUS) developed in 2 weeks after transplantation in 14 patients and in one later. Histopathologic examination demonstrated glomerular type of TMA in 3 patients, mixed type (glomerular and vascular) in 11 patients, and mesangial widening with non specific tubulo‐interstitial lesions with progression to glomerular type of TMA in repeated biopsy in one patient. Follow‐up biopsies revealed resolution of TMA in four patients and chronic vascular TMA in one patient. Six patients with mixed types of TMA needed transient hemodialysis, nobody with glomerular type needed dialysis (P = 0.103) and 14/15 had good resolution of graft function after Cs dose reduction; only 1 graft with mixed type TMA was lost due to irreversible HUS. Mean glomerular filtration rate (GFR) as predicted by the Nankivell equation was 76 ± 13 mL/min and 80 ± 27 mL/min 1 month after discharge for the glomerular type of TMA and mixed type, respectively (NS). Glomerular filtration rates 1 year after HUS were 82 ± 12 and 87 ± 21 mL/min (NS) for glomerular and mixed types, respectively. We concluded that mixed type of TMA was associated with more severe early clinical course than glomerular type of TMA. Long‐term prognosis seems good in majority of patients with no significant differences between the glomerular and mixed type of TMA.