Eculizumab in acute recurrence of thrombotic microangiopathy after renal transplantation

Article Article scientifique Rapport de cas Eculizumab in acute recurrence of thrombotic microangiopathy after renal transplantation eng 2011 author Hadaya Karine 34570 author Ferrari-Lacraz Sylvie 36049 author Fumeaux Delphine 505171 author Boehlen Françoise 33004 author Toso Christian 0000-0003-1652-4522 92271 author Moll Solange 28349 author Martin Pierre-Yves 65591 author Villard Jean 29595 2523-2527 10.1111/j.1600-6143.2011.03696.x 21831149 1600-6135 Renal thrombotic microangiopathy (TMA) is a severe complication of systemic lupus erythematosus (SLE), which is associated with the presence of antiphospholipid (aPL) antibodies. In its most fulminant form, TMA leads to a rapid and irreversible end-stage renal failure. Eculizumab, an anti-C5 monoclonal antibody, is a novel therapy of choice for patients with paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome. Here, we report the case of a 27-year-old woman, known for SLE and end-stage renal disease due to fulminant TMA. Both aPL antibodies and antinucleosome antibodies were positive. The patient underwent a living-related kidney transplantation with immediate production of urine. Although serum creatinine was remaining high, a graft biopsy, performed on day 6, demonstrated a TMA recurrence. Despite a treatment with plasma exchange, the situation got worse and dialysis was started. Eculizumab treatment was subsequently administered and renal function improved rapidly. Three months after transplantation, serum creatinine was at 100 μmol/L, without proteinuria. This case illustrates the benefit of eculizumab therapy in a fulminant recurrence of TMA after kidney transplantation, resistant to classical therapy. Antibodies, Antiphospholipid/blood Antibodies, Monoclonal, Humanized/therapeutic use Female Humans Kidney Failure, Chronic/etiology Kidney Transplantation/adverse effects Lupus Erythematosus, Systemic/complications Recurrence Thrombotic Microangiopathies/drug therapy Dewey 616 Dewey 616.07 Dewey 617 137 Département de pathologie et immunologie 21F 56 Département de médecine 221 57 Département de chirurgie 222 false 393 Analyse protéomique et Analyse génomique des maladies rénales 659 21 Groupe Pierre-Yves Martin (néphrologie) 30 298 Immunologie de transplantation, immunogénétique et thérapie cellulaire 561 562 Transplantation et hépatologie 905 American journal of transplantation 11 11 04d0faa7-d2ea-4a3d-9d93-488b8ff82e5b Article (Published version) Restricted 2011_hadaya_am_j_transpl.pdf 427300 application/pdf restrictedAccess Faculté de médecine / Section de médecine fondamentale / Département de pathologie et immunologie Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de chirurgie

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Eculizumab in acute recurrence of thrombotic microangiopathy after renal transplantation	American journal of transplantation			2011	754	0

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Fumeaux, Delphine