Outcomes of plasma exchange in patients with transplant-associated thrombotic microangiopathy based on time of presentation since transplant

Sudhanshu Mulay, Justin D. Kreuter, Sandra C. Bryant, Michelle A. Elliott, William Hogan, Jeffrey L. Winters, Dennis A. Gastineau

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Transplant-associated thrombotic microangiopathy (TA-TMA) is a rare clinical syndrome associated with significant mortality. Although the use of plasma exchange (PE) in TA-TMA continues to be explored, evidence for its efficacy is debated. We performed a single institution, retrospective study to evaluate the efficacy of PE in treating TA-TMA patients. Special attention was given to efficacy in relation to the timing of presentation with TA-TMA since transplant. Thirty-three patients diagnosed with TA-TMA and treated with PE between January 1999 and December 2010 were included in the study. Clinical improvement was seen in eight patients (24%); four patients achieved complete resolution while the remaining four achieved partial resolution. All-cause day-30 and day-100 mortality was 33 and 55%, respectively. There was a trend toward a better outcome (complete/partial) for those presenting ≥ 100 days after transplantation (42%) vs. < 100 days after transplantation (14%; P-value = 0.15). Similarly, those presenting at ≥ 100 days had better, but not significantly, 30-day and 100-day all-cause mortality rates (17 and 33%, respectively) than those presenting at < 100 days (43 and 67%, respectively) (P-value = 0.25 and 0.08, for 30- and 100-day all-cause mortality, respectively). This is the first study looking at the efficacy of PE while considering the time of presentation since transplantation and is one of the largest single institution series of TA-TMA. The overall efficacy of PE is poor; however, patients who present with TA-TMA ≥100 days after transplant may have better outcome and lower mortality.

Original languageEnglish (US)
Pages (from-to)147-153
Number of pages7
JournalJournal of Clinical Apheresis
Volume30
Issue number3
DOIs
StatePublished - Jun 1 2015

Fingerprint

Thrombotic Microangiopathies
Plasma Exchange
Transplants
Mortality
Transplantation
Retrospective Studies

Keywords

  • ADAMTS13
  • Microangiopathic hemolytic anemia
  • Thrombotic thrombocytopenic purpura

ASJC Scopus subject areas

  • Hematology

Cite this

Outcomes of plasma exchange in patients with transplant-associated thrombotic microangiopathy based on time of presentation since transplant. / Mulay, Sudhanshu; Kreuter, Justin D.; Bryant, Sandra C.; Elliott, Michelle A.; Hogan, William; Winters, Jeffrey L.; Gastineau, Dennis A.

In: Journal of Clinical Apheresis, Vol. 30, No. 3, 01.06.2015, p. 147-153.

Research output: Contribution to journalArticle

Mulay, Sudhanshu ; Kreuter, Justin D. ; Bryant, Sandra C. ; Elliott, Michelle A. ; Hogan, William ; Winters, Jeffrey L. ; Gastineau, Dennis A. / Outcomes of plasma exchange in patients with transplant-associated thrombotic microangiopathy based on time of presentation since transplant. In: Journal of Clinical Apheresis. 2015 ; Vol. 30, No. 3. pp. 147-153.
@article{fb01a0af776e48668fbd88d9e44fd3ad,
title = "Outcomes of plasma exchange in patients with transplant-associated thrombotic microangiopathy based on time of presentation since transplant",
abstract = "Transplant-associated thrombotic microangiopathy (TA-TMA) is a rare clinical syndrome associated with significant mortality. Although the use of plasma exchange (PE) in TA-TMA continues to be explored, evidence for its efficacy is debated. We performed a single institution, retrospective study to evaluate the efficacy of PE in treating TA-TMA patients. Special attention was given to efficacy in relation to the timing of presentation with TA-TMA since transplant. Thirty-three patients diagnosed with TA-TMA and treated with PE between January 1999 and December 2010 were included in the study. Clinical improvement was seen in eight patients (24{\%}); four patients achieved complete resolution while the remaining four achieved partial resolution. All-cause day-30 and day-100 mortality was 33 and 55{\%}, respectively. There was a trend toward a better outcome (complete/partial) for those presenting ≥ 100 days after transplantation (42{\%}) vs. < 100 days after transplantation (14{\%}; P-value = 0.15). Similarly, those presenting at ≥ 100 days had better, but not significantly, 30-day and 100-day all-cause mortality rates (17 and 33{\%}, respectively) than those presenting at < 100 days (43 and 67{\%}, respectively) (P-value = 0.25 and 0.08, for 30- and 100-day all-cause mortality, respectively). This is the first study looking at the efficacy of PE while considering the time of presentation since transplantation and is one of the largest single institution series of TA-TMA. The overall efficacy of PE is poor; however, patients who present with TA-TMA ≥100 days after transplant may have better outcome and lower mortality.",
keywords = "ADAMTS13, Microangiopathic hemolytic anemia, Thrombotic thrombocytopenic purpura",
author = "Sudhanshu Mulay and Kreuter, {Justin D.} and Bryant, {Sandra C.} and Elliott, {Michelle A.} and William Hogan and Winters, {Jeffrey L.} and Gastineau, {Dennis A.}",
year = "2015",
month = "6",
day = "1",
doi = "10.1002/jca.21352",
language = "English (US)",
volume = "30",
pages = "147--153",
journal = "Journal of Clinical Apheresis",
issn = "0733-2459",
publisher = "Wiley-Liss Inc.",
number = "3",

}

TY - JOUR

T1 - Outcomes of plasma exchange in patients with transplant-associated thrombotic microangiopathy based on time of presentation since transplant

AU - Mulay, Sudhanshu

AU - Kreuter, Justin D.

AU - Bryant, Sandra C.

AU - Elliott, Michelle A.

AU - Hogan, William

AU - Winters, Jeffrey L.

AU - Gastineau, Dennis A.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Transplant-associated thrombotic microangiopathy (TA-TMA) is a rare clinical syndrome associated with significant mortality. Although the use of plasma exchange (PE) in TA-TMA continues to be explored, evidence for its efficacy is debated. We performed a single institution, retrospective study to evaluate the efficacy of PE in treating TA-TMA patients. Special attention was given to efficacy in relation to the timing of presentation with TA-TMA since transplant. Thirty-three patients diagnosed with TA-TMA and treated with PE between January 1999 and December 2010 were included in the study. Clinical improvement was seen in eight patients (24%); four patients achieved complete resolution while the remaining four achieved partial resolution. All-cause day-30 and day-100 mortality was 33 and 55%, respectively. There was a trend toward a better outcome (complete/partial) for those presenting ≥ 100 days after transplantation (42%) vs. < 100 days after transplantation (14%; P-value = 0.15). Similarly, those presenting at ≥ 100 days had better, but not significantly, 30-day and 100-day all-cause mortality rates (17 and 33%, respectively) than those presenting at < 100 days (43 and 67%, respectively) (P-value = 0.25 and 0.08, for 30- and 100-day all-cause mortality, respectively). This is the first study looking at the efficacy of PE while considering the time of presentation since transplantation and is one of the largest single institution series of TA-TMA. The overall efficacy of PE is poor; however, patients who present with TA-TMA ≥100 days after transplant may have better outcome and lower mortality.

AB - Transplant-associated thrombotic microangiopathy (TA-TMA) is a rare clinical syndrome associated with significant mortality. Although the use of plasma exchange (PE) in TA-TMA continues to be explored, evidence for its efficacy is debated. We performed a single institution, retrospective study to evaluate the efficacy of PE in treating TA-TMA patients. Special attention was given to efficacy in relation to the timing of presentation with TA-TMA since transplant. Thirty-three patients diagnosed with TA-TMA and treated with PE between January 1999 and December 2010 were included in the study. Clinical improvement was seen in eight patients (24%); four patients achieved complete resolution while the remaining four achieved partial resolution. All-cause day-30 and day-100 mortality was 33 and 55%, respectively. There was a trend toward a better outcome (complete/partial) for those presenting ≥ 100 days after transplantation (42%) vs. < 100 days after transplantation (14%; P-value = 0.15). Similarly, those presenting at ≥ 100 days had better, but not significantly, 30-day and 100-day all-cause mortality rates (17 and 33%, respectively) than those presenting at < 100 days (43 and 67%, respectively) (P-value = 0.25 and 0.08, for 30- and 100-day all-cause mortality, respectively). This is the first study looking at the efficacy of PE while considering the time of presentation since transplantation and is one of the largest single institution series of TA-TMA. The overall efficacy of PE is poor; however, patients who present with TA-TMA ≥100 days after transplant may have better outcome and lower mortality.

KW - ADAMTS13

KW - Microangiopathic hemolytic anemia

KW - Thrombotic thrombocytopenic purpura

UR - http://www.scopus.com/inward/record.url?scp=84930846314&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930846314&partnerID=8YFLogxK

U2 - 10.1002/jca.21352

DO - 10.1002/jca.21352

M3 - Article

VL - 30

SP - 147

EP - 153

JO - Journal of Clinical Apheresis

JF - Journal of Clinical Apheresis

SN - 0733-2459

IS - 3

ER -