Incidence, Risk Factors for and Outcomes of Transplant‐Associated Thrombotic Microangiopathy

Autor: Narendranath Epperla, Ang Li, Brent Logan, Caitrin Fretham, Saurabh Chhabra, Mahmoud Aljurf, Lynette Chee, Edward Copelan, César O. Freytes, Peiman Hematti, Hillard M. Lazarus, Mark Litzow, Taiga Nishihori, Richard F. Olsson, Tim Prestidge, Wael Saber, Baldeep Wirk, Jean A. Yared, Alison Loren, Marcelo Pasquini, Allistair A. Abraham, Vaibhav Agrawal, Medhat Askar, Pere Barba, Alice Bertaina, Jean‐Yves Cahn, Jan Cerny, Hannah K. Choe, Miguel Angel Diaz, Christopher Dvorak, Nosha Farhadfar, Shahinaz M. Gadalla, Usama Gergis, Siddhartha Ganguly, Shahrukh Hashmi, Kimberly A. Kasow, Sunita Nathan, Roomi Nusrat, Sachiko Seo, Niketa C. Shah
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
Thrombotic microangiopathy
Adolescent
medicine.medical_treatment
Twins
Hematopoietic stem cell transplantation
urologic and male genital diseases
Disease-Free Survival
03 medical and health sciences
Sex Factors
0302 clinical medicine
Risk Factors
immune system diseases
hemic and lymphatic diseases
Internal medicine
medicine
Humans
Cumulative incidence
Renal replacement therapy
Child
Survival rate
Aged
Aged
80 and over
Thrombotic Microangiopathies
business.industry
Incidence
Incidence (epidemiology)
Hematopoietic Stem Cell Transplantation
Infant
Hematology
Middle Aged
Allografts
medicine.disease
female genital diseases and pregnancy complications
Renal Replacement Therapy
Survival Rate
surgical procedures
operative
Child
Preschool
030220 oncology & carcinogenesis
Sirolimus
Female
Unrelated Donors
Complication
business
030215 immunology
medicine.drug
Zdroj: British Journal of Haematology. 189:1171-1181
ISSN: 1365-2141
0007-1048
Popis: Transplant-associated thrombotic microangiopathy (TA-TMA) is a complication of allogeneic transplantation (allo-HCT). The incidence and risk factors associated with TA-TMA are not well known. A retrospective analysis from the Center for International Blood and Marrow Transplant Research (CIBMTR) was conducted including patients receiving allo-HCT between 2008 and 2016, with the primary objective of evaluating the incidence of TA-TMA. Secondary objectives included identification of risk factors associated with TA-TMA, and the impact of TA-TMA on overall survival and the need for renal replacement therapy (RRT). Among 23,665 allo-HCT recipients, the 3-year cumulative incidence of TA-TMA was 3%. Variables independently-associated with increased incidence of TA-TMA included female sex, prior autologous transplant, primary disease (acute lymphoblastic leukaemia and severe aplastic anaemia), donor type (mismatched or unrelated donor), conditioning intensity (myeloablative), GVHD prophylaxis (sirolimus + calcineurin inhibitor), pre-transplant kidney dysfunction and acute GVHD (time-varying effect). TA-TMA was associated with higher mortality (HR = 3·1, 95% Confidence Interval [CI] = 2·8-16·3) and RRT requirement (HR = 7·1, 95% CI = 5·7-311·6). This study provides epidemiologic data on TA-TMA and its impact on transplant outcomes. Increased awareness of the risk factors will enable providers to be vigilant of this uncommon but serious transplant complication. The results will also provide benchmarking for future study designs and comparisons.
Databáze: OpenAIRE
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