Please use this identifier to cite or link to this item: http://ir.swu.ac.th/jspui/handle/123456789/15433
Title: Renal thrombotic microangiopathy after hematopoietic cell transplant: Role of GVHD in pathogenesis
Authors: Changsirikulchai S.
Myerson D.
Guthrie K.A.
McDonald G.B.
Alpers C.E.
Hingorani S.R.
Keywords: aciclovir
amphotericin
cyclosporin A
HLA antigen
tacrolimus
acute graft versus host disease
Adenovirus
adult
age
aplastic anemia
article
autopsy
controlled study
Cytomegalovirus
death
dialysis
disease association
disease severity
donor
female
graft infection
graft recipient
hematologic malignancy
hematopoietic stem cell transplantation
Herpes simplex virus
histopathology
HLA matching
human
human tissue
kidney failure
kidney parenchyma
lymphoma
major clinical study
male
multiple myeloma
myelodysplastic syndrome
pathogenesis
prevalence
radiation dose
sex difference
thrombotic thrombocytopenic purpura
Varicella zoster virus
whole body radiation
adenovirus infection
adolescent
aged
child
graft versus host reaction
hematopoietic stem cell transplantation
hospitalization
infant
kidney
kidney disease
middle aged
mortality
pathology
preschool child
risk
risk assessment
risk factor
statistical model
thrombocytopenia
thrombosis
Adenoviridae Infections
Adolescent
Adult
Aged
Autopsy
Child
Child, Preschool
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Infant
Kidney
Kidney Diseases
Logistic Models
Male
Middle Aged
Odds Ratio
Prevalence
Radiation Dosage
Risk Assessment
Risk Factors
Severity of Illness Index
Sex Factors
Thrombocytopenia
Thrombosis
Young Adult
Issue Date: 2009
Abstract: Background and objectives: Thrombotic microangiopathy (TMA) is a known complication of hematopoietic cell transplantation (HCT). The etiology and diagnosis of TMA in this patient population is often difficult because thrombocytopenia, microangiopathic hemolytic anemia, and kidney injury occur frequently in HCT recipients, and are the result of a variety of insults. Design, setting, participants & measurements: The authors reviewed renal pathology and clinical data from HCT patients to determine the prevalence of TMA and to identify correlative factors for developing TMA in the kidney. Kidney tissue was evaluated from 314 consecutive autopsies on patients who died after their first HCT (received between 1992 and 1999). Renal pathology was classified into three groups: (1) no renal thrombus (65%), (2) TMA (20%), and (3) isolated thrombosis (15%). Logistic regression models estimated the associations between each histologic category and clinical parameters: donor and recipient gender, patient age, human leukocyte antigen (HLA) matching of the donor and recipient, total body irradiation (TBI), acute graft versus host disease (GVHD), acute kidney injury, medications, and viral infections. Results: In a multivariate analysis, TMA correlated with acute GVHD grades II to IV, followed by female recipient/male donor, TBI > 1200 cGy, and adenovirus infection. Grades II to IV acute GVHD and female gender were associated with isolated renal thrombus. Conclusions: TMA in HCT recipients is associated with acute GVHD grades II to IV, recipient/donor mismatch, TBI > 1200 cGy, and adenovirus infection. Copyright © 2009 by the American Society of Nephrology.
URI: https://www.scopus.com/inward/record.uri?eid=2-s2.0-66849128214&doi=10.2215%2fCJN.02070508&partnerID=40&md5=fa8c2deb43b8f6be52e114b163eb0e71
http://ir.swu.ac.th/jspui/handle/123456789/15433
ISSN: 15559041
Appears in Collections:Scopus 1983-2021

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