Alternate complement dysregulation postrenal transplantation can result in thrombotic microangiopathy (TMA). There is a scarcity of data regarding outcomes based on the timing of TMA post-transplant, coupled with a lack of follow-up biopsy findings post TMA diagnosis. This study aims to assess allograft and patient outcomes in individuals developing early TMA, defined within 4months post-transplantation, and explore any differences in follow-up surveillance biopsies compared to a non-TMA group. This is a single center retrospective study between January 1, 2002 and October 10, 2019. Patients who developed TMA within 4months post-transplantation were compared to a propensity matched non-TMA group. Thirty-one patients developed TMA within 4months of renal transplantation. Index TMA biopsy featured noticeable glomerular, and vascular lesions along with acute tubular injury. Four-month surveillance biopsy showed significant glomerulitis, transplant glomerulopathy and chronic interstitial fibrosis as compared to non-TMA group. However, at 1year, these differences were no longer significant. There was no significant difference in patient survival (TMA vs. non-TMA, p=0.083); however, death censored graft survival was significantly lower in the TMA group (p<0.001). TMA patients had a significantly lower estimated glomerular filtration rate at 4months and at 1year as compared to the non-TMA group. Early onset TMA post renal transplant leads to decreased renal function and lower graft survival. Early recognition and prompt treatment may help in reducing the adverse outcomes.
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