*Purpose: Transplant associated thrombotic microangiopathy (TA-TMA) is characterized by endothelial injury along with thrombocytopenia, microangiopathic hemolytic anemia (MAHA) and kidney graft dysfunction. It can be recurrent or de novo. We noticed cases with low levels of ADAMTS13 that didn’t meet criteria for TTP. We aim to described TA -TMA cases in the immediate post-operative period.

*Methods: Retrospective data collection of 11 deceased donor kidney transplant recipients at our center with TA-TMA less than 2 weeks from transplant. Donor and recipients’ variables were collected. Resolution was defined as platelet count > 100K and no need for transfusion. We use Thymoglobulin, Basiliximab and Steroids for induction and Tacrolimus plus Mycophenolate for maintenance immunosuppression.

*Results: Basic demographics and group analysis are shown in Table 1. TA-TMA was diagnosed on post op day 3 ± 1.3 with a mean platelet count of 45 ± 19 x 10(3) /mcl and ADAMTS 13 level Less 10% in 54% of the cases. TA-TMA recovered in 10 ± 2.4 days to a platelet count of 130 ± 67 x 10(3)/mcl.We found no statistical differences when the patients were grouped by the presence of post-operative bleeding except on the sCr at 3 months of 1 ± 0.35 mg/dl vs 2 ± 0.7 mg/dl in the bleeding vs non-bleeding group, respectively (p=0.018). The recovery time in the bleeding group was longer when FFP and plasmapheresis were provided in comparison to conservative management (11 vs 9 days).

*Conclusions: TA-TMA in the early postoperative period is difficult to diagnose and treat. 36% were related to reperfusion injury where the consumption of ADAMTS 13 could be explained by direct endothelial damage. TA-TMA occurs post op Day 3 with resolution by post of Day 10, regardless of treatment used. There was high 75% incidence of DGF with 87% of these having full recovery and reaching a significant better Scr when TA-TMA was related to a bleeding event. It remains unclear why 55% of the cases had reduction of ADAMTS 13 to less 10% as well as if its caused by endothelial damage vs consumption, therefore further research in this area is needed.

« Back to 2022 American Transplant Congress