Renal thrombotic microangiopathy associated with anticardiolipin antibodies in hepatitis C positive renal allograft recipients
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:674A 1997
Thrombotic microangiopathy is an infrequent but serious complication in the allograft kidney. The differential diagnosis most often revolves around antibody mediated rejection, cyclosporine or tacrolimus toxicity, ischemic injury, and recurrent hemolytic uremic syndrome. Less common conditions include malignant hypertension, infections, malignancy and collagen vascular disease.
Baid et al followed the clinical course of 18 patients infected with hepatitis C at the time of kidney transplantation. Five patients (27.8%) developed thrombotic microangiopathy 5-120 days (median 14) post-operatively. Anticardiolipin antibodies were found in 5/5 patients with and 1/13 without this complication. These antibodies were not present in a control group of 7 hepatitis C negative patients, who also developed allograft thrombotic microangiopathy. Death occurred in 4/5 antibody positive and 0/13 antibody negative patients within 5 years. The actual cause of death is not stated.
The observation made by these authors is very interesting and important, but needs to be reproduced in larger cohorts of patients at other medical centers. If the high incidence of thrombotic microangiopathy in this clinical setting is confirmed, pre-transplant testing for anticardiolipin antibodies may have to be mandated for all hepatitis C infected patients listed for renal transplantation.
(Parmjeet Randhawa, M.D., Presbyterian-University Hospital, Pittsburgh, PA)
References:
Porter KA. Renal transplantation. In: Pathology of the Kidney Ed. RH Heptinstall. Little Brown & Co. Boston 1799-1934, 1992.
Lambert R, Henry M, Howden B, Jablonski P, Rae D, Tavanlis G, Marshall V, Tange J. Glomerular damage after kidney preservation. Transplantation 1986;42:125-128.
Randhawa PS, Tsamandas AC, Magnone M, Jordan M, Shapiro R, Starzl TE, Demetris AJ. Microvascular changes in renal allografts associated with FK506 (Tacrolimus) therapy. Am J Surg Pathol 1996, 20:306-312.
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ASN 30th Annual Meeting, San Antonio
Transplant : Transplantation
ARF etiology : Cyclosporine, ARF in transplant patients