Publication:
Renal thrombotic microangiopathy after hematopoietic cell transplant: Role of GVHD in pathogenesis

2
0

Issued Date

2009

Resource Type

Article

File Type

application/pdf

ISSN

15559041

DOI

10.2215/CJN.02070508

Other identifier(s)

2-s2.0-66849128214

Rights Holder(s)

Scopus

Bibliographic Citation

Clinical Journal of the American Society of Nephrology. Vol 4, No.2 (2009), p.345-353

Suggested Citation

Changsirikulchai S., Myerson D., Guthrie K.A., Mcdonald G.B., Alpers C.E., Hingorani S.R. Renal thrombotic microangiopathy after hematopoietic cell transplant: Role of GVHD in pathogenesis. Clinical Journal of the American Society of Nephrology. Vol 4, No.2 (2009), p.345-353. doi:10.2215/CJN.02070508 Retrieved from: https://hdl.handle.net/20.500.14740/7638

Title

Renal thrombotic microangiopathy after hematopoietic cell transplant: Role of GVHD in pathogenesis

Author(s)

Changsirikulchai S.
 Myerson D.
 Guthrie K.A.
 Mcdonald G.B.
 Alpers C.E.
 Hingorani S.R.

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.

Subject(s)

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

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URI

https://hdl.handle.net/20.500.14740/7638

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Scopus: Year 1983-2021

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