{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:48:11Z","timestamp":1785908891292,"version":"3.56.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl. Int."],"abstract":"<jats:p>\n                    Secondary thrombotic microangiopathy (sTMA) is a rare but severe complication after lung transplantation. We performed a multicenter retrospective cohort study including adult lung transplant recipients diagnosed with\n                    <jats:italic>de novo<\/jats:italic>\n                    sTMA between 2010 and 2023 across five European transplant centers. The primary outcome was incidence of sTMA, with secondary outcomes including clinical presentation, treatment strategies, renal outcomes, and survival. Among 3,747 lung transplantations, 49 cases of sTMA were identified, corresponding to an incidence of 1.33%. Median time to diagnosis was 312 days (IQR 93\u2013546), with 53% occurring within the first post-transplant year. All patients presented with acute kidney injury and laboratory signs of hemolysis, neurological complications were observed in 8%. Therapeutic approaches included plasma exchange (46.9%), anti-C5 therapy (24.5%), and sequential plasma exchange followed by complement inhibition (10.2%). At follow-up, 65.3% developed chronic kidney disease, 20.4% progressed to end-stage renal disease, and 10.2% died during the acute episode. No significant association between treatment modality and renal or survival outcomes was observed. sTMA after lung transplantation is infrequent but associated with substantial renal morbidity and mortality. Early recognition through assessment of hemolysis and kidney injury, supported by renal biopsy in selected cases, may facilitate timely diagnosis and management.\n                  <\/jats:p>","DOI":"10.3389\/ti.2026.16046","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:10:13Z","timestamp":1785906613000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Secondary thrombotic microangiopathy following lung transplantation: a multicenter European cohort study"],"prefix":"10.3389","volume":"39","author":[{"given":"Zsofia","family":"Rosselli","sequence":"first","affiliation":[{"name":"Department of Pulmonology, University Hospital of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Havlin","sequence":"additional","affiliation":[{"name":"Lung Transplant Program, Third Department of Surgery, First Faculty of Medicine, Charles University in Prague and Motol University Hospital","place":["Prague, Czechia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berta","family":"Saez-Gimenez","sequence":"additional","affiliation":[{"name":"Lung Transplant Program, Department of Pulmonology Hospital Universitari Vall Hebron","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois M.","family":"Carlier","sequence":"additional","affiliation":[{"name":"Pneumologie et Transplantation Pulmonaire, UCL Namur University Hospital | Godinne Site","place":["Namur, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Murak\u00f6zy","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Medical University Vienna","place":["Vienna, 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Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Kozakowski","sequence":"additional","affiliation":[{"name":"Department of Pathology, Medical University Vienna","place":["Vienna, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Gaggl","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna","place":["Vienna, Austria"]},{"name":"Center for Public Health, Department of Social and Preventive Medicine, Medical University Vienna","place":["Vienna, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna","place":["Vienna, 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