PMID- 19144762
OWN - NLM
STAT- MEDLINE
DCOM- 20090611
LR  - 20211020
IS  - 1555-905X (Electronic)
IS  - 1555-9041 (Print)
IS  - 1555-9041 (Linking)
VI  - 4
IP  - 2
DP  - 2009 Feb
TI  - Renal thrombotic microangiopathy after hematopoietic cell transplant: role of 
      GVHD in pathogenesis.
PG  - 345-53
LID - 10.2215/CJN.02070508 [doi]
AB  - BACKGROUND AND OBJECTIVES: Thrombotic microangiopathy (TMA) is a known 
      complication of hematopoietic cell transplantation (HCT). The etiology and 
      diagnosis of TMA in this patient population is often difficult because 
      thrombocytopenia, microangiopathic hemolytic anemia, and kidney injury occur 
      frequently in HCT recipients, and are the result of a variety of insults. DESIGN, 
      SETTING, PARTICIPANTS & MEASUREMENTS: The authors reviewed renal pathology and 
      clinical data from HCT patients to determine the prevalence of TMA and to 
      identify correlative factors for developing TMA in the kidney. Kidney tissue was 
      evaluated from 314 consecutive autopsies on patients who died after their first 
      HCT (received between 1992 and 1999). Renal pathology was classified into three 
      groups: (1) no renal thrombus (65%), (2) TMA (20%), and (3) isolated thrombosis 
      (15%). Logistic regression models estimated the associations between each 
      histologic category and clinical parameters: donor and recipient gender, patient 
      age, human leukocyte antigen (HLA) matching of the donor and recipient, total 
      body irradiation (TBI), acute graft versus host disease (GVHD), acute kidney 
      injury, medications, and viral infections. RESULTS: In a multivariate analysis, 
      TMA correlated with acute GVHD grades II to IV, followed by female recipient/male 
      donor, TBI > 1200 cGy, and adenovirus infection. Grades II to IV acute GVHD and 
      female gender were associated with isolated renal thrombus. CONCLUSIONS: TMA in 
      HCT recipients is associated with acute GVHD grades II to IV, recipient/donor 
      mismatch, TBI > 1200 cGy, and adenovirus infection.
FAU - Changsirikulchai, Siribha
AU  - Changsirikulchai S
AD  - Department of Medicine, Srinakharinwirot University, Bangkok, Thailand.
FAU - Myerson, David
AU  - Myerson D
FAU - Guthrie, Katherine A
AU  - Guthrie KA
FAU - McDonald, George B
AU  - McDonald GB
FAU - Alpers, Charles E
AU  - Alpers CE
FAU - Hingorani, Sangeeta R
AU  - Hingorani SR
LA  - eng
GR  - CA18029/CA/NCI NIH HHS/United States
GR  - K23 DK063038/DK/NIDDK NIH HHS/United States
GR  - P01 CA018029/CA/NCI NIH HHS/United States
GR  - K23 DK63038/DK/NIDDK NIH HHS/United States
GR  - HL3644/HL/NHLBI NIH HHS/United States
GR  - CA5704/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20090114
PL  - United States
TA  - Clin J Am Soc Nephrol
JT  - Clinical journal of the American Society of Nephrology : CJASN
JID - 101271570
SB  - IM
MH  - Adenoviridae Infections/complications
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Autopsy
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Graft vs Host Disease/*complications/mortality/pathology
MH  - Hematopoietic Stem Cell Transplantation/*adverse effects/mortality
MH  - Humans
MH  - Infant
MH  - Kidney/pathology
MH  - Kidney Diseases/*etiology/mortality/pathology
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Prevalence
MH  - Radiation Dosage
MH  - Risk Assessment
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Sex Factors
MH  - Thrombocytopenia/*etiology/mortality/pathology
MH  - Thrombosis/*etiology/mortality/pathology
MH  - Young Adult
PMC - PMC2637592
EDAT- 2009/01/16 09:00
MHDA- 2009/06/12 09:00
PMCR- 2010/02/01
CRDT- 2009/01/16 09:00
PHST- 2009/01/16 09:00 [entrez]
PHST- 2009/01/16 09:00 [pubmed]
PHST- 2009/06/12 09:00 [medline]
PHST- 2010/02/01 00:00 [pmc-release]
AID - CJN.02070508 [pii]
AID - 0508 [pii]
AID - 10.2215/CJN.02070508 [doi]
PST - ppublish
SO  - Clin J Am Soc Nephrol. 2009 Feb;4(2):345-53. doi: 10.2215/CJN.02070508. Epub 2009 
      Jan 14.