Assessing the Impact of Prophylactic Eculizumab on Renal Graft Survival in Atypical Hemolytic Uremic Syndrome. Issue 4 (31st March 2023)

• Record Type: Journal Article
• Authors: Glover, Emily K.; Smith-Jackson, Kate; Brocklebank, Vicky; Wilson, Valerie; Walsh, Patrick R.; Montgomery, Emma K.; Wong, Edwin K.S.; Johnson, Sally; Malina, Michal; Kavanagh, David; Sheerin, Neil S.
• Other Names: Ahmed Aimun author non-byline.; Ashby Damien author non-byline.; Awan Atif author non-byline.; Baker Richard author non-byline.; Bhandari Sunil author non-byline.; Bingham Coralie author non-byline.; Bommayya Girish author non-byline.; Border David author non-byline.; Breen Cormac author non-byline.; Brown Henry author non-byline.; Brown Alison author non-byline.; Carmichael Paul author non-byline.; Chowdhury Paramit author non-byline.; Curran Simon author non-byline.; Donne Rosie author non-byline.; Dudley Chris author non-byline.; Dutt Tina author non-byline.; Eardley Kevin author non-byline.; Eblamo-Abad Elinor author non-byline.; Gale Daniel author non-byline.; Griffin Sian author non-byline.; Harty John author non-byline.; Hewins Peter author non-byline.; Holt Richard author non-byline.; Ingham Victoria author non-byline.; Kilbride Hannah author non-byline.; Kingdon Ed author non-byline.; Lewis Robert author non-byline.; Mansfield Nicholas author non-byline.; Marks Stephen D author non-byline.; Mason Phil author non-byline.; Mead Paul author non-byline.; Morton Muir author non-byline.; Muniraju Thalakunte author non-byline.; Nagaraja Pramod author non-byline.; Padmanabhan Neal author non-byline.; Plant Nicholas author non-byline.; Raftery Tara author non-byline.; Rowe Peter author non-byline.; Salama Alan author non-byline.; Shenbagaraman Packiam author non-byline.; Taylor Alison author non-byline.; Tomlinson Kerry author non-byline.; Torpey Nick author non-byline.; Uniacke Mark author non-byline.; Walbaum David author non-byline.; Webb Michelle author non-byline.; Williams Matt author non-byline.; Woodman Alastair author non-byline.; Shah Sapna author non-byline.; Saif Imran author non-byline.;
• Is Part Of: Transplantation. Volume 107:Issue 4(2023)
• Page Start: 994
• Page End: 1003
• Publication Date: 2023-03-31
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000004355
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Atypical hemolytic uremic syndrome (aHUS) is a rare cause of end-stage kidney disease and associated with poor outcomes after kidney transplantation from early disease recurrence. Prophylactic eculizumab treatment at the time of transplantation is used in selected patients with aHUS. We report a retrospective case note review describing transplant outcomes in patients with aHUS transplanted between 1978 and 2017, including those patients treated with eculizumab. Methods: The National Renal Complement Therapeutics Centre database identified 118 kidney transplants in 86 recipients who had a confirmed diagnosis of aHUS. Thirty-eight kidney transplants were performed in 38 recipients who received prophylactic eculizumab. The cohort not treated with eculizumab comprised 80 transplants in 60 recipients and was refined to produce a comparable cohort of 33 transplants in 32 medium and high-risk recipients implanted since 2002. Complement pathway genetic screening was performed. Graft survival was censored for graft function at last follow-up or patient death. Graft survival without eculizumab treatment is described by complement defect status and by Kidney Disease: Improving Global Outcomes risk stratification. Results: Prophylactic eculizumab treatment improved renal allograft survival ( P = 0.006) in medium and high-risk recipients with 1-y survival of 97% versus 64% in untreated patients. Our data supports the risk stratification advised by Kidney Disease: Improving Global Outcomes. Conclusions: Prophylactic eculizumab treatment dramatically improves graft survival making transplantation a viable therapeutic option in aHUS. Abstract :