HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.01781105v1 1/4/811    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nishi, H. Articles by Fujita, T. Search for Related Content PubMed PubMed Citation Articles by Nishi, H. Articles by Fujita, T.

Clinical Outcome of Thrombotic Microangiopathy after Living-Donor Liver Transplantation Treated with Plasma Exchange Therapy

Hiroshi Nishi^*,, Norio Hanafusa^*,, Yasushi Kondo^*,, Masaomi Nangaku, Yasuhiko Sugawara, Masatoshi Makuuchi, Eisei Noiri^*,,||, and Toshiro Fujita^*,

^* Department of Hemodialysis and Apheresis, Department of Nephrology and Endocrinology, Department of Urology, Department of Surgery, ^|| Center for NanoBio Integration, University of Tokyo, Tokyo, Japan

Address correspondence to: Dr. Eisei Noiri, Department of Nephrology & Endocrinology 107 Lab, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan. Phone: +81-3-3815-5411; Fax: +81-3-5800-8725; E-mail: noiri-tky{at}umin.ac.jp

Thrombotic microangiopathy (TMA) is a well-documented but severe complication that occurs after solid-organ transplant. Administration of calcineurin inhibitors is considered a major cause of this fatal complication; prompt initiation of plasma exchange therapy after reduction or conversion of calcineurin inhibitors has been recommended. Nevertheless, little is known about clinical evidence of this strategy against TMA after solid-organ, especially non–renal-organ, transplantation. Medical records of 63 patients who were hospitalized at Artificial Organ and Transplantation Division in Tokyo University Hospital and underwent blood purification therapy between January 1999 and May 2005 were reviewed. Twenty-eight living-donor liver transplantation (LDLT) recipients who received plasma exchange therapy were identified, and 18 of them were found retrospectively to receive a diagnosis of having TMA. Of the 18 patients, 10 (56%) responded to this therapy and survived after the treatment was stopped, whereas eight (44%) patients died before improvement. Subsequent follow-up of patients clarified that 1-yr survival rate of post-LDLT TMA was approximately 30%. Multivariate Cox proportional-hazards regression analysis demonstrated that the interval between transplant surgery and onset of TMA (hazard ratio 1.35 per 30 d; 95% confidence interval 1.07 to 1.71; P = 0.021) and pretreatment blood urea nitrogen level (hazard ratio 1.39 per 10 mg/dl; 95% confidence interval 1.02 to 1.90; P = 0.037) predicted mortality. Analyses identified post-LDLT recipients with TMA as being at high risk for poor prognosis. Effective strategies are needed for late-onset TMA after LDLT to improve treatment response and survival.