Ex Vivo Test of Complement Dysregulation in Atypical Hemolytic Uremic Syndrome Kidney Transplant patients: A Pilot Study.
Kidney Int Rep
; 9(1): 145-151, 2024 Jan.
Article
em En
| MEDLINE
| ID: mdl-38312782
ABSTRACT
Introduction:
In 2014, a complement assay, which evaluates C5b-9 deposition on endothelial cells, was proposed as a biomarker for atypical hemolytic uremic syndrome (aHUS). Early diagnosis and/or prediction of aHUS (relapse) is pivotal in aHUS kidney transplant recipients who do not receive eculizumab prophylaxis.Methods:
In this pilot study, serum samples of transplanted patients with aHUS in remission without eculizumab and patients with other primary kidney diseases (controls) were blinded and evaluated in the complement assay.Results:
We included 13 patients with aHUS (4 males, 9 females) of median age of 54 years (range 35-69) and median of 5.9 years (range 0.25-14.1) after transplantation; and 13 controls (7 males, 6 females) of median age of 42 years (range 27-60) and median of 5.8 years (range 1.6-11.7) after transplantation. There were no significant differences in C5b-9 deposits between patients with aHUS and controls on resting cells (median of 136% [range 93%-382%] and 121% [range 75%-200%], respectively) and activated cells (median of 196% [range 99%-388%] and 170% [range 113%-260%], respectively). Three patients with aHUS and 4 controls showed elevated C5b-9 deposits on resting cells, which should correspond to active aHUS. None of these patients had laboratory signs of thrombotic microangiopathy (TMA). During follow-up (15.8 months, range 6-21), estimated glomerular filtration rate remained stable in all. In 5 patients with aHUS with a genetic variant, no increase in C5b-9 deposits was found on activated endothelial cells, which contrasts with the literature suggesting that the test should identify carriers of a genetic variant.Conclusion:
Our data question the routine use of the ex vivo complement assay in kidney transplant patients. Future studies should evaluate the test characteristics of assay in kidney transplant patients.
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MEDLINE
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En
Ano de publicação:
2024
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Article