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 |
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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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