Assessing the Impact of Prophylactic Eculizumab on Renal Graft Survival in Atypical Hemolytic Uremic Syndrome.
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
medline:
4
4
2023
pubmed:
23
11
2022
entrez:
22
11
2022
Statut:
ppublish
Résumé
Atypical hemolytic uremic syndrome (aHUS) is a rare cause of end-stage kidney disease and associated with poor outcomes after kidney transplantation from early disease recurrence. Prophylactic eculizumab treatment at the time of transplantation is used in selected patients with aHUS. We report a retrospective case note review describing transplant outcomes in patients with aHUS transplanted between 1978 and 2017, including those patients treated with eculizumab. The National Renal Complement Therapeutics Centre database identified 118 kidney transplants in 86 recipients who had a confirmed diagnosis of aHUS. Thirty-eight kidney transplants were performed in 38 recipients who received prophylactic eculizumab. The cohort not treated with eculizumab comprised 80 transplants in 60 recipients and was refined to produce a comparable cohort of 33 transplants in 32 medium and high-risk recipients implanted since 2002. Complement pathway genetic screening was performed. Graft survival was censored for graft function at last follow-up or patient death. Graft survival without eculizumab treatment is described by complement defect status and by Kidney Disease: Improving Global Outcomes risk stratification. Prophylactic eculizumab treatment improved renal allograft survival ( P = 0.006) in medium and high-risk recipients with 1-y survival of 97% versus 64% in untreated patients. Our data supports the risk stratification advised by Kidney Disease: Improving Global Outcomes. Prophylactic eculizumab treatment dramatically improves graft survival making transplantation a viable therapeutic option in aHUS.
Sections du résumé
BACKGROUND
Atypical hemolytic uremic syndrome (aHUS) is a rare cause of end-stage kidney disease and associated with poor outcomes after kidney transplantation from early disease recurrence. Prophylactic eculizumab treatment at the time of transplantation is used in selected patients with aHUS. We report a retrospective case note review describing transplant outcomes in patients with aHUS transplanted between 1978 and 2017, including those patients treated with eculizumab.
METHODS
The National Renal Complement Therapeutics Centre database identified 118 kidney transplants in 86 recipients who had a confirmed diagnosis of aHUS. Thirty-eight kidney transplants were performed in 38 recipients who received prophylactic eculizumab. The cohort not treated with eculizumab comprised 80 transplants in 60 recipients and was refined to produce a comparable cohort of 33 transplants in 32 medium and high-risk recipients implanted since 2002. Complement pathway genetic screening was performed. Graft survival was censored for graft function at last follow-up or patient death. Graft survival without eculizumab treatment is described by complement defect status and by Kidney Disease: Improving Global Outcomes risk stratification.
RESULTS
Prophylactic eculizumab treatment improved renal allograft survival ( P = 0.006) in medium and high-risk recipients with 1-y survival of 97% versus 64% in untreated patients. Our data supports the risk stratification advised by Kidney Disease: Improving Global Outcomes.
CONCLUSIONS
Prophylactic eculizumab treatment dramatically improves graft survival making transplantation a viable therapeutic option in aHUS.
Identifiants
pubmed: 36413152
doi: 10.1097/TP.0000000000004355
pii: 00007890-202304000-00034
pmc: PMC10065821
doi:
Substances chimiques
eculizumab
A3ULP0F556
Complement System Proteins
9007-36-7
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
994-1003Subventions
Organisme : Medical Research Council
ID : MR/R001359/1
Pays : United Kingdom
Organisme : Wellcome Trust
Pays : United Kingdom
Investigateurs
Aimun Ahmed
(A)
Damien Ashby
(D)
Atif Awan
(A)
Richard Baker
(R)
Sunil Bhandari
(S)
Coralie Bingham
(C)
Girish Bommayya
(G)
David Border
(D)
Cormac Breen
(C)
Henry Brown
(H)
Alison Brown
(A)
Paul Carmichael
(P)
Paramit Chowdhury
(P)
Simon Curran
(S)
Rosie Donne
(R)
Chris Dudley
(C)
Tina Dutt
(T)
Kevin Eardley
(K)
Elinor Eblamo-Abad
(E)
Daniel Gale
(D)
Sian Griffin
(S)
John Harty
(J)
Peter Hewins
(P)
Richard Holt
(R)
Victoria Ingham
(V)
Hannah Kilbride
(H)
Ed Kingdon
(E)
Robert Lewis
(R)
Nicholas Mansfield
(N)
Stephen D Marks
(SD)
Phil Mason
(P)
Paul Mead
(P)
Muir Morton
(M)
Thalakunte Muniraju
(T)
Pramod Nagaraja
(P)
Neal Padmanabhan
(N)
Nicholas Plant
(N)
Tara Raftery
(T)
Peter Rowe
(P)
Alan Salama
(A)
Packiam Shenbagaraman
(P)
Alison Taylor
(A)
Kerry Tomlinson
(K)
Nick Torpey
(N)
Mark Uniacke
(M)
David Walbaum
(D)
Michelle Webb
(M)
Matt Williams
(M)
Alastair Woodman
(A)
Sapna Shah
(S)
Imran Saif
(I)
Informations de copyright
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
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