Table 4.
Eculizumab in kidney transplant associated TMA*.
| Cause | n | Previous management | Eculizumab duration | Outcomes after eculizumab | Comments |
|---|---|---|---|---|---|
| CAPS (83, 85) | 8 | Usual CAPS treatment | 5w-Indefinite | 3 pt: no CAPS relapse 5 pt: TMA resolution |
CAPS prophylaxis in KT TMA treatment |
| Early CA (donor factors, Drugs) (53–61) | 10 | Treatment of the offending event PE |
2 w−4 m** | 7 pt: renal recovery and TMA resolution 1 pt: PRR 2 pt: graft loss |
In all patients: more than one causal event 2 patients shared the same donor, indicating pre-tx CA |
| CMV (71) | 1 | Antiviral | 1 yr | TMA resolution | Eculizumab+Valganciclovir |
| PT-TMA (97) | 15 | DW, DR PE 12 pt |
2-52 w | TMA resolution Kidney function improvement |
No graft loss No recurrence after ecu discontinuation |
| MAT PT (98) | 16 Early 6 Late |
DW,DR PE 13/16 pt PE 6/6 pt |
3 w 11 w |
8/11: CRR 2/11: PRR 1/6: CRR 2/6: PRR 3/6: Graft Loss |
A shorter interval between TMA diagnosis and eculizumab leads to a better kidney function recovery |
*
Antibody mediated rejection related TMA is not included.
**
In one patient, the length of treatment is not described.
CAPS, Catastrophic antiphospholipid syndrome; Pt, patients; KT, kidney transplant; CA, complement activation; PE, plasma exchange; CRR, complete renal remission, PRR, partial renal remission; DW, drug withdrawal; DR, drug reduction.