Thrombotic microangiopathy in the early post-renal transplant period

The aim of this study was to identify cases of post-renal transplant thrombotic microangiopathy in a single transplant center over a period of five years. In a retrospective study, we reviewed the renal biopsy specimens of 57 renal transplant recipients with allograft dysfunction. The presence of fibrin thrombi within the glomerular capillaries or arterioles was used to define thrombotic microangiopathy. Systemic thrombotic microangiopathy was justified with the presence of thrombocytopenia and evidence of microangiopathic hemolysis. Patients with the biopsy findings compatible with thrombotic microangiopathy but without any systemic findings were categorized as having localized thrombotic microangiopathy. Four out of 57 patients had systemic thrombotic microangiopathy, while two had localized disease. The characteristics of each patient are discussed. Post-transplant thrombotic microangiopathy constitutes 10.5% of cases of early renal allograft dysfunction. A high index of suspicion is needed for diagnosing this entity as a potential cause of post-kidney transplant allograft dysfunction. Further studies with a greater number of patients may be required to highlight the risk factors for post-renal transplant thrombotic microangiopathy.