{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:31:00Z","timestamp":1753889460131,"version":"3.41.2"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T00:00:00Z","timestamp":1734998400000},"content-version":"vor","delay-in-days":358,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Nephrology"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Thrombotic microangiopathy is a severe complication of renal transplantation. Little is known about risk factors, incidence of autoantibodies against complement components, and prognosis.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Clinical and laboratory data were retrospectively collected for 13 patients diagnosed with post\u2010transplant thrombotic microangiopathy (PT\u2010TMA) in 2011\u20132018. Enzyme\u2010linked immunosorbent assay (ELISA) results were compared to transplant recipients without PT\u2010TMA and healthy controls.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Nine patients (69%) had potential PT\u2010TMA risk factors other than exposure to calcineurin inhibitors (CNIs). Stratification by time to PT\u2010TMA yielded two groups. Patients diagnosed within 6\u2009months of transplantation (<jats:italic>n<\/jats:italic>\u2009=\u20096) were characterized by positive donor\u2010specific antibody (DSA) test, complement\u2010associated renal disease, and acute rejection. Two had IgG and IgA autoantibodies to complement Factors H and I, respectively. Patients diagnosed \u2265 3\u2009years after transplantation (<jats:italic>n<\/jats:italic>\u2009=\u20097) had a high rate of infection. Renal biopsy yielded dense deposits in 6 patients, and only one with primary immune complex renal disease. Within 2\u2009years, graft failure requiring dialysis occurred in 6 patients (46%). Three patients with early\u2010onset PT\u2010TMA showed improved renal function and remained stable under eculizumab treatment. Epstein\u2013Barr virus (EBV)\u2013associated post\u2010transplant lymphoproliferative disorder (EPTLD) developed in 3 patients, 2 of whom had received eculizumab for more than 5\u2009years. Five patients (39%) died during follow\u2010up.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> In this study, PT\u2010TMA was associated with other risk factors besides CNI exposure, with differences by time of onset from transplantation. Prognosis was generally poor but better for early\u2010onset PT\u2010TMA managed with eculizumab. The development of late EPTLD in 3 patients raises concerns.<\/jats:p>","DOI":"10.1155\/ijne\/4396051","type":"journal-article","created":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T14:16:16Z","timestamp":1735049776000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comprehensive Analysis of Thrombotic Microangiopathy Following Renal Transplantation"],"prefix":"10.1155","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9247-2999","authenticated-orcid":false,"given":"Ittai","family":"Fattal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tali","family":"Steinmetz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Donin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Foigelman","family":"Tobar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benaya","family":"Rozen-Zvi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Rahamimov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eviatar","family":"Nesher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Idit","family":"Shirazi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eytan","family":"Mor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilan","family":"Babai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zvi","family":"Fishelson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,24]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1432-2277.1996.tb00855.x"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006080811"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-05-221549"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2007-09-109876"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfr436"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03156.x"},{"key":"e_1_2_13_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000004585"},{"key":"e_1_2_13_8_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2020081224"},{"key":"e_1_2_13_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2011.152"},{"key":"e_1_2_13_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4939-8958-4_3"},{"key":"e_1_2_13_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1592"},{"key":"e_1_2_13_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2023.10.016"},{"key":"e_1_2_13_13_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2018070759"},{"key":"e_1_2_13_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0060352"},{"key":"e_1_2_13_15_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-11-611335"},{"key":"e_1_2_13_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/0006-2952(90)90295-V"},{"key":"e_1_2_13_17_2","first-page":"455","article-title":"Cyclosporin-Induced Endothelial Cell Injury","volume":"55","author":"Zoja C C.","year":"1986","journal-title":"Laboratory Investigation; a journal of technical methods and pathology"},{"key":"e_1_2_13_18_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.1999.00492.x"},{"key":"e_1_2_13_19_2","first-page":"580","article-title":"Tacrolimus-Associated Hemolytic Uremic Syndrome: A Case Analysis","volume":"16","author":"Lin C. 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