Thrombotic microangiopathy after kidney transplantation: Expanding etiologic and pathogenetic spectra

作     者：Muhammed Mubarak Amber Raza Rahma Rashid Fnu Sapna Shaheera Shakeel 

作者机构：Department of HistopathologySindh Institute of Urology and TransplantationKarachi 74200SindhPakistan Department of NephrologySindh Institute of Urology and TransplantationKarachi 74200SindhPakistan Department of PathologyMontefiore Medical CenterThe University Hospital for Albert Einstein School of MedicineBronxNY 10461United States 

出 版 物：《World Journal of Transplantation》 (世界移植杂志)

年 卷 期：2024年第14卷第1期

页      面：84-95页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Thrombotic microangiopathy Microvascular injury Anemia Thrombocytopenia Kidney allograft failure 

摘      要：Thrombotic microangiopathy(TMA)is an uncommon but serious complication that not only affects native kidneys but also transplanted *** review is specifically focused on post-transplant TMA(PT-TMA)involving kidney transplant *** reported prevalence in the latter population varies from 0.8%to 14%with adverse impacts on both graft and patient *** has many causes and associations,and the list of etiologic agents and associations is growing *** pathogenesis is equally varied and a variety of pathogenetic pathways lead to the development of microvascular injury as the final common ***-TMA is categorized in many ways in order to facilitate its ***,more than one causes are contributory in PT-TMA and it is often difficult to pinpoint one particular cause in an individual ***,the hallmark lesions are endothelial cell injury and intravascular thrombi affecting the *** diagnosis and classification of PT-TMA are imperative for optimal outcomes but are challenging for both clinicians and *** Banff classification has addressed this issue and has developed minimum diagnostic criteria for pathologic diagnosis of PT-TMA in the first *** of the condition is also challenging and still largely *** varies from simple maneuvers,such as plasmapheresis,drug withdrawal or modification,or dose reduction,to lifelong complement blockade,which is very expensive.A thorough understanding of the condition is imperative for an early diagnosis and quick treatment when the treatment is potentially *** review aims to increase the awareness of relevant stakeholders regarding this important,potentially treatable but under-recognized cause of kidney allograft dysfunction.