Eculizumab as Salvage Treatment for Thrombotic Microangiopathy After Lung Transplantation

• Published in: Clinical transplantation 2024-09, Vol.38 (9), p.e15443-n/a
• Main Authors: Trujillo, Hernando, Huerta, Ana, Alonso, Rodrigo, Serrano, Maria Luisa, Aguilar, Myriam, Morales, Enrique, Cavero, Teresa
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibodies, Monoclonal, Humanized - therapeutic use; complement biology; Complement Inactivating Agents - therapeutic use; Female; Follow-Up Studies; Graft Rejection - drug therapy; Graft Rejection - etiology; Graft Survival - drug effects; Humans; kidney failure/injury; Kidney Function Tests; lung (allograft) function/dysfunction; Lung Transplantation - adverse effects; Male; Middle Aged; Postoperative Complications - drug therapy; Postoperative Complications - etiology; Prognosis; Retrospective Studies; Risk Factors; Salvage Therapy; Thrombotic Microangiopathies - drug therapy; Thrombotic Microangiopathies - etiology
• ISSN: 0902-0063; 1399-0012; 1399-0012
• DOI: 10.1111/ctr.15443

ABSTRACT Background Thrombotic microangiopathy (TMA) is a rare complication after lung transplantation (LT) that has seldom been characterized in detail. Recent evidence has linked TMA other than primary atypical hemolytic uremic syndrome (aHUS) with hyperactivation of the complement alternative pathway. The focus of this investigation was to analyze the treatment response with eculizumab in TMA after LT. Methods Case series where we have studied 11 patients with TMA after LT from 2 Spanish tertiary healthcare centers. Clinical data and response rates to eculizumab are provided. Results The main indication for lung transplant was chronic obstructive pulmonary disease (COPD) (36%) and most cases (82%) received bilateral LT. The median time to TMA diagnosis was 11.6 months (4.7–28.9) and the TMA trigger in the majority of cases (73%) was immunosuppressive drugs. Platelet and hemoglobin nadir were 58 × 103/µL (24–108) and 7.7 g/dL (7.1–7.9), respectively. All cases presented acute kidney injury (AKI) with a median creatinine of 4 mg/dL (3.2–4.8) and 54.5% required acute dialysis. Eculizumab was started after a median time of 8 days (6–14) with a median duration of 3 weeks (2–8). Complete TMA response was observed in 7 (63.6%) cases and hematologic response in 10 (90.9%). The time to hematologic and renal response was 23 days (13–29) and 28 days (14–46), respectively. Conclusions TMA after LT is infrequent but potentially devastating. Our findings suggest that short cycles of eculizumab may be effective for severe TMA after LT.