De-novo-thrombotische Mikroangiopathie (TMA) nach inkompatibler AB0-Nierentransplantation

Zusammenfassung

Anamnese Wir berichten über einen 57-jährigen Patienten, der in unserer Klinik zur geplanten AB0-inkompatiblen Lebendnierentransplantation aufgenommen wurde.

Untersuchungen und Diagnose An Tag 3 post operationem bildeten sich laborchemisch eindeutige Hinweise für eine Denovo-TMA aus. Die renale Entgiftung stagnierte bei initialem regelrechtem Verlauf.

Therapie und Verlauf Durch den Einsatz von Eculizumab 900 mg an d3 und d10 post operationem konnten wir die TMA mit einem anhaltenden Erfolg unterbinden.

Folgerung Zu diskutieren ist, ob ein frühzeitiger Einsatz von Eculizumab bei V. a. De-novo-TMA ein sicherer Weg ist, eine Transplantatdysfunktion zu unterbinden und somit die in der Literatur beschriebene schlechte Prognose für Transplantat und Empfänger zu verbessern.

Abstract

History We report a 57-year-old patient admitted to our hospital for planned AB0-incompatible living kidney transplantation.

Findings and Diagnosis On day 3 post operationem, clear laboratory evidence of de novo TMA developed. Renal detoxification stagnated with initial regular course.

Therapy and Course By using eculizumab 900 mg on d3 and d10 post operationem, we were able to suppress TMA with a sustained success.

Conclusion It has to be discussed whether an early use of eculizumab in cases of suspected de novo TMA is a safe way to prevent graft dysfunction and thus to improve the poor prognosis for graft and recipient described in the literature.

Schlüsselwörter

Nierentransplantation - AB0-inkompatibel - TMA - thrombotische Mikroangiopathie

Key words

renal transplantation - AB0 incompatible - TMA - thrombotic microangiopathy

• Literatur

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