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• W2008320854 abstract "PurposeThrombotic microangiopathy (TMA) has an incidience of 0,8-14% after solid organ transplantation with thrombotic-thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) as the two major clinical syndromes. Immunosuppressive drugs, especially calcineurin-inhibitors (CNI) and mTOR-inhibitors, are reported as a potential cause of TMA. The purpose of this study was to describe the incidence, course and management of TMA in a large collective of patients after lung transplantation(LUTX).MethodsWe retrospectively analyzed all primary LUTX in our centre performed between 1999 and 2012. 864 bi-lateral, 162 uni-lateral and 18 combined heart-lung-transplantations entered the analysis. All cases of TMA were identified according to laboratory findings and outcomes were analyzed.ResultsTMA occurred in 21 patients (2.0 %) after a median of 264 (4-1759) days post LUTX. All patients received CNI´s (combined with MMF and steroids) as primary immunosuppression (IS) and induction therapy was administered in 9 patients. 6 patients were switched to Everolimus prior to TMA diagnosis. Therapy consisted of a modification in IS in all patients and additionally plasmapheresis was performed in 12 patients. Eculizumab was applied to one patient. There was no difference overall survival after LUTX in patients with and without TMA (logrank 0.221). However all patients with TMA had a clinical relevant infection shortly prior to the diagnosis of TMA. Kidney function recovered in 12 patients, all others remained on dialysis. Survival after TMA-diagnosis was 691.4±860.9 (mean±SD) and median 372 (21-3697) days. No other significant differences or risk factors for TMA could be found.ConclusionTMA after LUTX is a rare complication and may be triggered by IS and infections. The present immunosuppressive therapy (i.e. CNI and/or mTOR) had no influence on the frequency of TMA occurrence. Therapy is carried out stepwise starting with a switch of IS up to plasmapheresis or antibody-treatment in persistent cases. PurposeThrombotic microangiopathy (TMA) has an incidience of 0,8-14% after solid organ transplantation with thrombotic-thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) as the two major clinical syndromes. Immunosuppressive drugs, especially calcineurin-inhibitors (CNI) and mTOR-inhibitors, are reported as a potential cause of TMA. The purpose of this study was to describe the incidence, course and management of TMA in a large collective of patients after lung transplantation(LUTX). Thrombotic microangiopathy (TMA) has an incidience of 0,8-14% after solid organ transplantation with thrombotic-thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) as the two major clinical syndromes. Immunosuppressive drugs, especially calcineurin-inhibitors (CNI) and mTOR-inhibitors, are reported as a potential cause of TMA. The purpose of this study was to describe the incidence, course and management of TMA in a large collective of patients after lung transplantation(LUTX). MethodsWe retrospectively analyzed all primary LUTX in our centre performed between 1999 and 2012. 864 bi-lateral, 162 uni-lateral and 18 combined heart-lung-transplantations entered the analysis. All cases of TMA were identified according to laboratory findings and outcomes were analyzed. We retrospectively analyzed all primary LUTX in our centre performed between 1999 and 2012. 864 bi-lateral, 162 uni-lateral and 18 combined heart-lung-transplantations entered the analysis. All cases of TMA were identified according to laboratory findings and outcomes were analyzed. ResultsTMA occurred in 21 patients (2.0 %) after a median of 264 (4-1759) days post LUTX. All patients received CNI´s (combined with MMF and steroids) as primary immunosuppression (IS) and induction therapy was administered in 9 patients. 6 patients were switched to Everolimus prior to TMA diagnosis. Therapy consisted of a modification in IS in all patients and additionally plasmapheresis was performed in 12 patients. Eculizumab was applied to one patient. There was no difference overall survival after LUTX in patients with and without TMA (logrank 0.221). However all patients with TMA had a clinical relevant infection shortly prior to the diagnosis of TMA. Kidney function recovered in 12 patients, all others remained on dialysis. Survival after TMA-diagnosis was 691.4±860.9 (mean±SD) and median 372 (21-3697) days. No other significant differences or risk factors for TMA could be found. TMA occurred in 21 patients (2.0 %) after a median of 264 (4-1759) days post LUTX. All patients received CNI´s (combined with MMF and steroids) as primary immunosuppression (IS) and induction therapy was administered in 9 patients. 6 patients were switched to Everolimus prior to TMA diagnosis. Therapy consisted of a modification in IS in all patients and additionally plasmapheresis was performed in 12 patients. Eculizumab was applied to one patient. There was no difference overall survival after LUTX in patients with and without TMA (logrank 0.221). However all patients with TMA had a clinical relevant infection shortly prior to the diagnosis of TMA. Kidney function recovered in 12 patients, all others remained on dialysis. Survival after TMA-diagnosis was 691.4±860.9 (mean±SD) and median 372 (21-3697) days. No other significant differences or risk factors for TMA could be found. ConclusionTMA after LUTX is a rare complication and may be triggered by IS and infections. The present immunosuppressive therapy (i.e. CNI and/or mTOR) had no influence on the frequency of TMA occurrence. Therapy is carried out stepwise starting with a switch of IS up to plasmapheresis or antibody-treatment in persistent cases. TMA after LUTX is a rare complication and may be triggered by IS and infections. The present immunosuppressive therapy (i.e. CNI and/or mTOR) had no influence on the frequency of TMA occurrence. Therapy is carried out stepwise starting with a switch of IS up to plasmapheresis or antibody-treatment in persistent cases." @default.
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• W2008320854 date "2014-04-01" @default.
• W2008320854 modified "2023-09-27" @default.
• W2008320854 title "Thrombotic Microangiopathy After Lung Transplantation" @default.
• W2008320854 doi "https://doi.org/10.1016/j.healun.2014.01.504" @default.
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