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Eculizumab in acute recurrence of thrombotic microangiopathy after renal transplantation

Published in American Journal of Transplantation. 2011, vol. 11, no. 11, p. 2523-7
Abstract 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.
Keywords Antibodies, Antiphospholipid/bloodAntibodies, Monoclonal, Humanized/therapeutic useFemaleHumansKidney Failure, Chronic/etiologyKidney Transplantation/adverse effectsLupus Erythematosus, Systemic/complicationsRecurrenceThrombotic Microangiopathies/drug therapy
PMID: 21831149
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Research groups Transplantation et hépatologie (905)
Groupe Pierre-Yves Martin (néphrologie) (30)
Transplantation Immunologie et Osteoimmunologie (561)
Analyse protéomique et Analyse génomique des maladies rénales (659)
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HADAYA, Karine et al. Eculizumab in acute recurrence of thrombotic microangiopathy after renal transplantation. In: American Journal of Transplantation, 2011, vol. 11, n° 11, p. 2523-7. https://archive-ouverte.unige.ch/unige:24806

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Deposited on : 2012-12-20

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