Long-term outcomes of the Atypical Hemolytic Uremic Syndrome after kidney transplantation treated with eculizumab as first choice

Detalhes bibliográficos
Autor(a) principal: Andrade, Luis Gustavo Modelli de [UNESP]
Data de Publicação: 2017
Outros Autores: 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]
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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spelling 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
language eng
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dc.publisher.none.fl_str_mv Public Library Science
publisher.none.fl_str_mv Public Library Science
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