Kidney transplant in patients with atypical hemolytic uremic syndrome in the anti-C5 era: single-center experience with tailored Eculizumab.

Antibodies, Monoclonal, Humanized / therapeutic use Atypical Hemolytic Uremic Syndrome / diagnosis Female Humans Kidney Transplantation / adverse effects Plasmapheresis

Eculizumab HUS relapse Hemolytic uremic syndrome Kidney transplantation

Journal

Journal of nephrology

ISSN: 1724-6059

Titre abrégé: J Nephrol

Pays: Italy

ID NLM: 9012268

Informations de publication

Date de publication:
Dec 2021

Historique:

received: 15 01 2021

accepted: 02 04 2021

pubmed: 7 5 2021

medline: 29 1 2022

entrez: 6 5 2021

Statut: ppublish

Résumé

Patients with atypical hemolytic uremic syndrome (aHUS) have long been considered ineligible for kidney transplantation (KTx) in several centers due to the high risk of disease recurrence, graft loss and life-threatening complications. The availability of Eculizumab (ECU) has now overcome this problem. However, the best approach towards timing, maintenance schedule, the possibility of discontinuation and patient monitoring has not yet been clearly established. This is a single center case series presenting our experience with KTx in aHUS. This study included 26 patients (16 females) with a diagnosis of aHUS, who spent a median of 5.5 years on kidney replacement therapy before undergoing KTx. We compared the aHUS relapse rate in three groups of patients who underwent KTx: patients who received no prophylaxis, patients who underwent plasma exchange, those who received Eculizumab prophylaxis. Complement factor H-related disease was by far the most frequent etiology (n = 19 patients). Untreated patients and patients undergoing pre-KTx plasma exchange prophylaxis had a relapse rate of 0.81 (CI 0.30-1.76) and 3.1 (CI 0.64-9.16) events per 10 years cumulative observation, respectively, as opposed to 0 events among patients receiving Eculizumab prophylaxis. The time between Eculizumab doses was tailored based on classic complement pathway activity (target to < 30%). Using this strategy, 12 patients are currently receiving Eculizumab every 28 days, 5 every 24-25 days, and 3 every 21 days. Our experience supports the prophylactic use of Eculizumab in patients with a previous history of aHUS undergoing KTx, especially when complement dysregulation is well documented by molecular biology.

Identifiants

DOI: 10.1007/s40620-021-01045-7 PMID: 33956337

pubmed: 33956337

doi: 10.1007/s40620-021-01045-7

pii: 10.1007/s40620-021-01045-7

doi:

Substances chimiques

Antibodies, Monoclonal, Humanized 0

eculizumab A3ULP0F556

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

2027-2036

Informations de copyright

Références

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