Use of Highly Individualized Complement Blockade Has Revolutionized Clinical Outcomes after Kidney Transplantation and Renal Epidemiology of Atypical Hemolytic Uremic Syndrome - Archive ouverte HAL Access content directly
Journal Articles Journal of the American Society of Nephrology Year : 2019

Use of Highly Individualized Complement Blockade Has Revolutionized Clinical Outcomes after Kidney Transplantation and Renal Epidemiology of Atypical Hemolytic Uremic Syndrome

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Julien Zuber
Marie Frimat
  • Function : Author
Sophie Caillard
  • Function : Author
Nassim Kamar
Philippe Gatault
Florent Petitprez
  • Function : Author
Lionel Couzi
Valérie Châtelet
  • Function : Author
Raphaël Gaisne
  • Function : Author
Dominique Bertrand
Jamal Bamoulid
  • Function : Author
Magali Louis
  • Function : Author
Charlotte Colosio
  • Function : Author
Antoine Thierry
  • Function : Author
Joseph Rivalan
  • Function : Author
Laetitia Albano
  • Function : Author
Nadia Arzouk
  • Function : Author
Emilie Cornec-Legall
  • Function : Author
Guillaume Claisse
  • Function : Author
Michelle Elias
  • Function : Author
Khalil El Karoui
  • Function : Author
Sophie Chauvet
  • Function : Author
Jean-Philippe Coindre
  • Function : Author
Jean Philippe Rerolle
  • Function : Author
Leïla Tricot
  • Function : Author
Johnny Sayegh
  • Function : Author
Cyril Garrouste
Christophe Charasse
  • Function : Author
Yahsou Delmas
  • Function : Author
Ziad Massy
  • Function : Author
Maryvonne Hourmant
  • Function : Author
Aude Servais
  • Function : Author
Chantal Loirat
  • Function : Author
Fadi Fakhouri
  • Function : Author
Claire Pouteil Noble
  • Function : Author
Marie Noelle Peraldi
  • Function : Author
Christophe Legendre
  • Function : Author
Eric Rondeau
Moglie Le Quintrec
  • Function : Author
Veronique Fremeaux-Bacchi
  • Function : Author

Abstract

Background Atypical hemolytic uremic syndrome (HUS) is associated with high recurrence rates after kidney transplant, with devastating outcomes. In late 2011, experts in France recommended the use of highly individualized complement blockade-based prophylaxis with eculizumab to prevent post-transplant atypical HUS recurrence throughout the country. Methods To evaluate this strategy's effect on kidney transplant prognosis, we conducted a retrospective multicenter study from a large French nationwide registry, enrolling all adult patients with atypical HUS who had undergone complement analysis and a kidney transplant since January 1, 2007. To assess how atypical HUS epidemiology in France in the eculizumab era evolved, we undertook a population-based cohort study that included all adult patients with atypical HUS (n=397) between 2007 and 2016. Results The first study included 126 kidney transplants performed in 116 patients, 58.7% and 34.1% of which were considered to be at a high and moderate risk of atypical HUS recurrence, respectively. Eculizumab prophylaxis was used in 52 kidney transplants, including 39 at high risk of recurrence. Atypical HUS recurred after 43 (34.1%) of the transplants; in four cases, patients had received eculizumab prophylaxis and in 39 cases they did not. Use of prophylactic eculizumab was independently associated with a significantly reduced risk of recurrence and with significantly longer graft survival. In the second, population-based cohort study, the proportion of transplant recipients among patients with ESKD and atypical HUS sharply increased between 2012 and 2016, from 46.2% to 72.3%, and showed a close correlation with increasing eculizumab use among the transplant recipients. Conclusions Results from this observational study are consistent with benefit from eculizumab prophylaxis based on pretransplant risk stratification and support the need for a rigorous randomized trial.

Dates and versions

hal-02556079 , version 1 (27-04-2020)

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Julien Zuber, Marie Frimat, Sophie Caillard, Nassim Kamar, Philippe Gatault, et al.. Use of Highly Individualized Complement Blockade Has Revolutionized Clinical Outcomes after Kidney Transplantation and Renal Epidemiology of Atypical Hemolytic Uremic Syndrome. Journal of the American Society of Nephrology, 2019, 30 (12), pp.2449-2463. ⟨10.1681/ASN.2019040331⟩. ⟨hal-02556079⟩

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