Long-term outcomes of the Atypical Hemolytic Uremic Syndrome after kidney transplantation treated with eculizumab as first choice
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1371/journal.pone.188155 http://hdl.handle.net/11449/163467 |
Resumo: | Introduction The treatment of choice for Atypical Hemolytic Uremic Syndrome (aHUS) is the monoclonal antibody eculizumab. The objective of this study was to assess the efficacy and safety of eculizumab in a cohort of kidney transplant patients suffering from aHUS. Methods Description of the prospective cohort of all the patients primarily treated with eculizumab after transplantation and divided into the therapeutic (onset of aHUS after transplantation) and prophylactic use (patients with previous diagnosis of aHUS undergoing kidney transplantation). Results Seven cases were outlined: five of therapeutic use and two, prophylactic. From the five cases of therapeutic use, there was improvement of the thrombotic microangiopathy in the 48 hours following the start of the drug and no patient experienced relapse during an average follow-up of 21 months in the continuous use of eculizumab (minimum of 6 and maximum of 42 months). One patient died at 6 months, due to Aspergillus infection. From the two cases of prophylactic use, one patient experienced relapsed thrombotic microangiopathy after 4 months and another patient remained asymptomatic after 16 months of follow-up, both on chronic treatment. Discussion The therapeutic use of eculizumab showed to be effective, with improvement of the microangiopathy parameters and persisting up to the end of the follow-up, without relapses. The additional risk of immunosuppression, leading to opportunistic infections, was well tolerated. The prophylactic use showed to be effective and safe; however, the doses and intervals should be individualized in order to avoid relapsed microangiopathy, especially in patients with factor H mutation. |
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Long-term outcomes of the Atypical Hemolytic Uremic Syndrome after kidney transplantation treated with eculizumab as first choiceIntroduction The treatment of choice for Atypical Hemolytic Uremic Syndrome (aHUS) is the monoclonal antibody eculizumab. The objective of this study was to assess the efficacy and safety of eculizumab in a cohort of kidney transplant patients suffering from aHUS. Methods Description of the prospective cohort of all the patients primarily treated with eculizumab after transplantation and divided into the therapeutic (onset of aHUS after transplantation) and prophylactic use (patients with previous diagnosis of aHUS undergoing kidney transplantation). Results Seven cases were outlined: five of therapeutic use and two, prophylactic. From the five cases of therapeutic use, there was improvement of the thrombotic microangiopathy in the 48 hours following the start of the drug and no patient experienced relapse during an average follow-up of 21 months in the continuous use of eculizumab (minimum of 6 and maximum of 42 months). One patient died at 6 months, due to Aspergillus infection. From the two cases of prophylactic use, one patient experienced relapsed thrombotic microangiopathy after 4 months and another patient remained asymptomatic after 16 months of follow-up, both on chronic treatment. Discussion The therapeutic use of eculizumab showed to be effective, with improvement of the microangiopathy parameters and persisting up to the end of the follow-up, without relapses. The additional risk of immunosuppression, leading to opportunistic infections, was well tolerated. The prophylactic use showed to be effective and safe; however, the doses and intervals should be individualized in order to avoid relapsed microangiopathy, especially in patients with factor H mutation.Univ Sao Paulo State, Dept Internal Med, UNESP, Botucatu, SP, BrazilHosp Estadual Bauru, Dept Internal Med, Bauru, SP, BrazilUniv Sao Paulo, Dept Internal Med, Sao Paulo, SP, BrazilUniv Estadual Campinas, Dept Internal Med, UNICAMP, Campinas, SP, BrazilUniv Sao Paulo State, Dept Internal Med, UNESP, Botucatu, SP, BrazilPublic Library ScienceUniversidade Estadual Paulista (Unesp)Hosp Estadual BauruUniversidade de São Paulo (USP)Universidade Estadual de Campinas (UNICAMP)Andrade, Luis Gustavo Modelli de [UNESP]Contti, Mariana Moraes [UNESP]Nga, Hong Si [UNESP]Bravin, Ariane Moyses [UNESP]Takase, Henrique Mochida [UNESP]Viero, Rosa Marlene [UNESP]Silva, Trycia Nunes da [UNESP]Chagas, Kelem De Nardi [UNESP]Pereira Palma, Lilian Monteiro [UNESP]2018-11-26T17:42:09Z2018-11-26T17:42:09Z2017-11-14info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article14application/pdfhttp://dx.doi.org/10.1371/journal.pone.188155Plos One. San Francisco: Public Library Science, v. 12, n. 11, 14 p., 2017.1932-6203http://hdl.handle.net/11449/16346710.1371/journal.pone.188155WOS:000415121200071WOS000415121200071.pdfWeb of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengPlos One1,164info:eu-repo/semantics/openAccess2024-08-14T17:22:58Zoai:repositorio.unesp.br:11449/163467Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-14T17:22:58Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Long-term outcomes of the Atypical Hemolytic Uremic Syndrome after kidney transplantation treated with eculizumab as first choice |
title |
Long-term outcomes of the Atypical Hemolytic Uremic Syndrome after kidney transplantation treated with eculizumab as first choice |
spellingShingle |
Long-term outcomes of the Atypical Hemolytic Uremic Syndrome after kidney transplantation treated with eculizumab as first choice Andrade, Luis Gustavo Modelli de [UNESP] |
title_short |
Long-term outcomes of the Atypical Hemolytic Uremic Syndrome after kidney transplantation treated with eculizumab as first choice |
title_full |
Long-term outcomes of the Atypical Hemolytic Uremic Syndrome after kidney transplantation treated with eculizumab as first choice |
title_fullStr |
Long-term outcomes of the Atypical Hemolytic Uremic Syndrome after kidney transplantation treated with eculizumab as first choice |
title_full_unstemmed |
Long-term outcomes of the Atypical Hemolytic Uremic Syndrome after kidney transplantation treated with eculizumab as first choice |
title_sort |
Long-term outcomes of the Atypical Hemolytic Uremic Syndrome after kidney transplantation treated with eculizumab as first choice |
author |
Andrade, Luis Gustavo Modelli de [UNESP] |
author_facet |
Andrade, Luis Gustavo Modelli de [UNESP] Contti, Mariana Moraes [UNESP] Nga, Hong Si [UNESP] Bravin, Ariane Moyses [UNESP] Takase, Henrique Mochida [UNESP] Viero, Rosa Marlene [UNESP] Silva, Trycia Nunes da [UNESP] Chagas, Kelem De Nardi [UNESP] Pereira Palma, Lilian Monteiro [UNESP] |
author_role |
author |
author2 |
Contti, Mariana Moraes [UNESP] Nga, Hong Si [UNESP] Bravin, Ariane Moyses [UNESP] Takase, Henrique Mochida [UNESP] Viero, Rosa Marlene [UNESP] Silva, Trycia Nunes da [UNESP] Chagas, Kelem De Nardi [UNESP] Pereira Palma, Lilian Monteiro [UNESP] |
author2_role |
author author author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) Hosp Estadual Bauru Universidade de São Paulo (USP) Universidade Estadual de Campinas (UNICAMP) |
dc.contributor.author.fl_str_mv |
Andrade, Luis Gustavo Modelli de [UNESP] Contti, Mariana Moraes [UNESP] Nga, Hong Si [UNESP] Bravin, Ariane Moyses [UNESP] Takase, Henrique Mochida [UNESP] Viero, Rosa Marlene [UNESP] Silva, Trycia Nunes da [UNESP] Chagas, Kelem De Nardi [UNESP] Pereira Palma, Lilian Monteiro [UNESP] |
description |
Introduction The treatment of choice for Atypical Hemolytic Uremic Syndrome (aHUS) is the monoclonal antibody eculizumab. The objective of this study was to assess the efficacy and safety of eculizumab in a cohort of kidney transplant patients suffering from aHUS. Methods Description of the prospective cohort of all the patients primarily treated with eculizumab after transplantation and divided into the therapeutic (onset of aHUS after transplantation) and prophylactic use (patients with previous diagnosis of aHUS undergoing kidney transplantation). Results Seven cases were outlined: five of therapeutic use and two, prophylactic. From the five cases of therapeutic use, there was improvement of the thrombotic microangiopathy in the 48 hours following the start of the drug and no patient experienced relapse during an average follow-up of 21 months in the continuous use of eculizumab (minimum of 6 and maximum of 42 months). One patient died at 6 months, due to Aspergillus infection. From the two cases of prophylactic use, one patient experienced relapsed thrombotic microangiopathy after 4 months and another patient remained asymptomatic after 16 months of follow-up, both on chronic treatment. Discussion The therapeutic use of eculizumab showed to be effective, with improvement of the microangiopathy parameters and persisting up to the end of the follow-up, without relapses. The additional risk of immunosuppression, leading to opportunistic infections, was well tolerated. The prophylactic use showed to be effective and safe; however, the doses and intervals should be individualized in order to avoid relapsed microangiopathy, especially in patients with factor H mutation. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-11-14 2018-11-26T17:42:09Z 2018-11-26T17:42:09Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1371/journal.pone.188155 Plos One. San Francisco: Public Library Science, v. 12, n. 11, 14 p., 2017. 1932-6203 http://hdl.handle.net/11449/163467 10.1371/journal.pone.188155 WOS:000415121200071 WOS000415121200071.pdf |
url |
http://dx.doi.org/10.1371/journal.pone.188155 http://hdl.handle.net/11449/163467 |
identifier_str_mv |
Plos One. San Francisco: Public Library Science, v. 12, n. 11, 14 p., 2017. 1932-6203 10.1371/journal.pone.188155 WOS:000415121200071 WOS000415121200071.pdf |
dc.language.iso.fl_str_mv |
eng |
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eng |
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Plos One 1,164 |
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info:eu-repo/semantics/openAccess |
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openAccess |
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14 application/pdf |
dc.publisher.none.fl_str_mv |
Public Library Science |
publisher.none.fl_str_mv |
Public Library Science |
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Web of Science reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
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Universidade Estadual Paulista (UNESP) |
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UNESP |
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UNESP |
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Repositório Institucional da UNESP |
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Repositório Institucional da UNESP |
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Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
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1808128140531204096 |