{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:28:25Z","timestamp":1786512505712,"version":"build-2736575974"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to explore the efficacy of eculizumab in the treatment of newly developed thrombotic microangiopathy (TMA) associated with acute T-cell-mediated rejection (ATCR) in patients with type 2 diabetes after kidney transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      New-onset thrombotic microangiopathy (TMA) after kidney transplantation is a relatively rare but serious complication that is clinically challenging to manage and requires timely intervention to prevent graft dysfunction or early graft loss. Currently, there is no consensus in clinical practice regarding the diagnosis, optimal treatment strategies, or preventive measures for post-transplant new-onset TMA. This article provides a retrospective analysis of the first case in China successfully treated with eculizumab for\n                      <jats:italic>de novo<\/jats:italic>\n                      TMA occurring in the context of acute T-cell-mediated rejection (ATCR), type 2 diabetes, and post-transplant immunosuppression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient<\/jats:title>\n                    <jats:p>The patient was a 59-year-old male who underwent cadaveric donor kidney transplantation on July 31, 2024. The surgery was successful, and postoperative recovery was good. He was followed up in the outpatient department every week. On September 15, 2024, the patient experienced acute pain and swelling in the right lower abdomen, and his 24-h urine output decreased to 1,200\u202fmL. After admission, biopsy of the transplanted kidney was performed, and severe thrombotic microangiopathy (TMA) was diagnosed. After pathological diagnosis, eculizumab was administered for 3\u202fmonths (900\u202fmg\/time in the first four weeks, once a week; 1,200\u202fmg\/time from the fifth week to the 12th week, once a week).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After eculizumab treatment, the patient\u2019s clinical symptoms improved significantly. Laboratory indicators, such as platelet count, lactate dehydrogenase (LDH), and serum creatinine (SCr) gradually returned to normal. During the 9-month follow-up after the last dose, the SCr level remained stable at 180\u202f\u03bcmol\/L, with no recurrence of thrombotic microangiopathy (TMA) and no signs of proteinuria were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Eculizumab is effective in treating new-onset ATCR-related TMA in patients with type 2 diabetes after kidney transplantation, and treatment should be initiated immediately after diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1872856","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:45:10Z","timestamp":1786509910000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Eculizumab for ATCR-associated de novo thrombotic microangiopathy in a Chinese kidney transplant recipient with type 2 diabetes: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Shunye","family":"Su","sequence":"first","affiliation":[{"name":"Department of Urology, Weifang People\u2019s Hospital, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Urology, Weifang People\u2019s Hospital, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiyan","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Pathology, Weifang People\u2019s Hospital, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhentao","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liqin","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Hospital Outpatient, Weifang People\u2019s Hospital, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Urology, Weifang People\u2019s Hospital, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"764.e1","DOI":"10.1016\/j.jtct.2022.07.029","article-title":"N-acetylcysteine as prophylactic therapy for transplantation-associated thrombotic microangiopathy: a randomized, placebo-controlled trial","volume":"28","author":"Pan","year":"2022","journal-title":"Transplant Cell Ther"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3106","DOI":"10.1016\/j.transproceed.2016.04.005","article-title":"Belatacept and eculizumab for treatment of calcineurin inhibitor-induced thrombotic microangiopathy after kidney transplantation: case report","volume":"48","author":"Merola","year":"2016","journal-title":"Transplant Proc"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1111\/nep.12768","article-title":"Two cases of kidney transplantation-associated thrombotic microangiopathy successfully treated with eculizumab","volume":"21","author":"Ikeda","year":"2016","journal-title":"Nephrology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/j.xkme.2020.06.007","article-title":"Use of eculizumab in transplant-associated thrombotic microangiopathy in a patient with polycystic kidney disease immediately post-kidney transplant: a case report","volume":"2","author":"Godara","year":"2020","journal-title":"Kidney Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1331","DOI":"10.4103\/1319-2442.308342","article-title":"Thrombotic microangiopathy in a renal allograft: single-center five-year experience","volume":"31","author":"Vanikar","year":"2020","journal-title":"Saudi J Kidney Dis Transpl"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1016\/j.ekir.2023.01.016","article-title":"Eculizumab rescue therapy in patients with recurrent atypical hemolytic uremic syndrome after kidney transplantation","volume":"8","author":"Duineveld","year":"2023","journal-title":"Kidney Int Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1805","DOI":"10.1038\/s41409-021-01283-0","article-title":"Transplant-associated thrombotic microangiopathy: theoretical considerations and a practical approach to an unrefined diagnosis","volume":"56","author":"Young","year":"2021","journal-title":"Bone Marrow Transplant"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"147","DOI":"10.5527\/wjn.v12.i5.147","article-title":"Bleeding complications after percutaneous kidney biopsies\u2014nationwide experience from Brunei Darussalam","volume":"12","author":"Lim","year":"2023","journal-title":"World J Nephrol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1056\/NEJMoa061648","article-title":"The complement inhibitor eculizumab in paroxysmal nocturnal hemoglobinuria","volume":"355","author":"Hillmen","year":"2006","journal-title":"N Engl J Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1186\/s12882-021-02456-1","article-title":"Complement activation and blockade in massive post-partum haemorrhage, thrombotic microangiopathy and acute kidney injury: a case report","volume":"22","author":"Guzzo","year":"2021","journal-title":"BMC Nephrol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e003573","DOI":"10.1136\/bmjopen-2013-003573","article-title":"A systematic review of eculizumab for atypical haemolytic uraemic syndrome (aHUS)","volume":"3","author":"Rathbone","year":"2013","journal-title":"BMJ Open"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/1750-1172-9-48","article-title":"Concerns about unapproved meningococcal vaccination for eculizumab therapy in Japan","volume":"9","author":"Tanimoto","year":"2014","journal-title":"Orphanet J Rare Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"sfag018","DOI":"10.1093\/ckj\/sfag018","article-title":"Thrombotic microangiopathy after kidney transplantation: diagnosis and management strategies","volume":"19","author":"Mirioglu","year":"2026","journal-title":"Clin Kidney J"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e0241989","DOI":"10.1371\/journal.pone.0241989","article-title":"Characteristics of and meningococcal disease prevention strategies for commercially insured persons receiving eculizumab in the United States","volume":"15","author":"Bozio","year":"2020","journal-title":"PLoS One"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1872856\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:45:16Z","timestamp":1786509916000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1872856\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":14,"alternative-id":["10.3389\/fmed.2026.1872856"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1872856","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"article-number":"1872856"}}