Exploring the role of the complement system, endothelial injury, and microRNAs in thrombotic microangiopathy after kidney transplantation.
J Int Med Res 2021;
48:300060520980530. [PMID:
33372813 PMCID:
PMC7783899 DOI:
10.1177/0300060520980530]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective
We investigated whether the recipient’s complement system function, kidney
graft endothelial ultrastructural injury, and microRNA (miRNA) expression
before transplantation may be associated with the risk of posttransplant
de novo thrombotic microangiopathy (TMA).
Methods
Complement system function assessment, histological and ultrastructural
examination of preimplantation and kidney graft biopsies, and microRNA
assessment were performed on kidney transplant recipients (KTRs) with
de novo TMA.
Results
On the basis of the clinical course, histological findings, and miRNA
patterns, the following two de novo TMA phenotypes were
observed: a self-limiting disease that was localized to the kidney graft and
a systemic disease that progressed to graft failure without timely
treatment. Decreased alternative complement pathway activity and
ultrastructural endothelial injury before transplantation were confirmed in
all five KTRs and four of five KTRs, respectively, but they did not
correlate with de novo TMA severity.
Conclusions
Alternative complement pathway abnormalities in KTRs and endothelial
ultrastructural injury on preimplantation biopsy might be associated with
de novo posttransplant TMA, although they did not
predict posttransplant TMA severity (localized vs.
systemic). The specific miRNA expression patterns in preimplantation kidney
graft biopsies demonstrated a borderline statistically significant
difference and might provide more accurate information on posttransplant TMA
severity.
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