Abstract: PUB364
Biopsy-Proven Thrombotic Angiopathy Early After Kidney Transplantation: Insights from a Single-Center Series
Session Information
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Jain, Swati, Montefiore Health System Inc, New York, New York, United States
- Al Azzi, Yorg, Montefiore Health System Inc, New York, New York, United States
- Liriano-Ward, Luz E., Montefiore Health System Inc, New York, New York, United States
- Pynadath, Cindy T., Montefiore Health System Inc, New York, New York, United States
- Akalin, Enver, Montefiore Health System Inc, New York, New York, United States
- Ajaimy, Maria, Montefiore Health System Inc, New York, New York, United States
Background
We aimed to characterize the clinical presentation, biopsy findings, and outcomes of patients with biopsy-proven thrombotic microangiopathy (TMA) post-kidney transplantation.
Methods
A retrospective analysis was conducted on 15 deceased-donor kidney transplant recipients (KTR) diagnosed with TMA
Results
There were 73% male, 60% blacks with a median age of 60 (50-70) years. The cause of ESKD was undetermined in 40% of the cohort and 93% were on dialysis. 40% received donation after cardiac death donors (DCD), median donor age of 43 (38-60) years, Kidney Donor Profile Index (KDPI) of 74% (51-83) and cold ischemia time (CIT) was 1390 (1140-2017) minutes. 80% received Anti Thymocyte Globulin and 20% Basiliximab induction. Patients underwent kidney biopsy at a median of 56 days after transplantation (24-164). At 3 months, 33% of the patients had eGFR < 15 ml/min and 40% had proteinuria >500 mg/day. 20% had Donor Specific Antibodies at time of biopsy but only one biopsy showed antibody-mediated rejection. There was a striking finding of chronic changes on biopsies with 93% showing tubular atrophy (ct), 86% interstitial fibrosis (ci), 79% vascular fibrosis (cv) suggesting donor-related chronic changes (Table). Only 3 patients underwent genetic testing and were positive for mutations in complement cascade. One-year patient and graft survival were 87% and 67 % respectively. Patients who lost their graft had a statistically significant higher Banff i-score, cg score, ct score and ci score (p <0.05) at the time of TMA diagnosis.
Conclusion
TMA is not common in our KTR but kidneys from donors with higher risk such as, chronic changes on biopsies, DCD donors, high KDPI scores and CIT time might be more susceptible to ischemia/reperfusion injury and development of TMA.