Use of Highly Individualized Complement Blockade Has Revolutionized Clinical Outcomes after Kidney Transplantation and Renal Epidemiology of Atypical Hemolytic Uremic Syndrome Article Swipe
Julien Zuber
,
Marie Frimat
,
Sophie Caillard
,
Nassim Kamar
,
Philippe Gatault
,
Florent Petitprez
,
Lionel Couzi
,
Noémie Jourde‐Chiche
,
Valérie Châtelet
,
Raphaël Gaisne
,
Dominique Bertrand
,
Jamal Bamoulid
,
Magali Louis
,
Rébecca Sberro‐Soussan
,
David Navarro
,
Pierre‐François Westeel
,
Luc Frimat
,
Charlotte Colosio
,
Antoine Thierry
,
Joseph Rivalan
,
Laetitia Albano
,
Nadia Arzouk
,
Émilie Cornec-Le Gall
,
Guillaume Claisse
,
Michelle Elias
,
Khalil El Karoui
,
Sophie Chauvet
,
Jean‐Philippe Coindre
,
Jean-Philippe Rérolle
,
Leïla Tricot
,
Johnny Sayegh
,
Cyril Garrouste
,
Christophe Charasse
,
Yahsou Delmas
,
Ziad A. Massy
,
Maryvonne Hourmant
,
Aude Servais
,
Chantal Loirat
,
Fádi Fakhouri
,
Claire Pouteil‐Noble
,
Marie‐Noelle Péraldi
,
Christophe Legendre
,
Éric Rondeau
,
Moglie Le Quintrec
,
Véronique Frémeaux‐Bacchi
·
YOU?
·
· 2019
· Open Access
·
· DOI: https://doi.org/10.1681/asn.2019040331
YOU?
·
· 2019
· Open Access
·
· DOI: https://doi.org/10.1681/asn.2019040331
Significance Statement Although complement blockade is highly effective for preventing recurrence of atypical hemolytic uremic syndrome (HUS) after kidney transplant, debates regarding the use of eculizumab prophylaxis continue because of its very high cost. An individualized strategy—using eculizumab prophylaxis specifically in patients with moderate- to high-risk kidney transplants, determined by complement analysis and a medical history of a previous recurrence—was implemented in France in 2011 and subsequently adopted more widely. In the authors’ retrospective study of patients with atypical HUS in France, they found that prophylactic use of eculizumab almost abolished the risk of recurrence and significantly increased graft survival, especially in high-risk transplants. It also led to a substantial expansion after 2012 of the transplanted population among patients with atypical HUS and ESKD. These findings support use of eculizumab prophylaxis based on pretransplant risk stratification. 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.
Related Topics
Concepts
Eculizumab
Medicine
Atypical hemolytic uremic syndrome
Population
Kidney transplantation
Transplantation
Epidemiology
Cohort
Internal medicine
Retrospective cohort study
Thrombotic microangiopathy
Surgery
Pediatrics
Immunology
Complement system
Disease
Antibody
Environmental health
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1681/asn.2019040331
- https://jasn.asnjournals.org/content/jnephrol/30/12/2449.full.pdf
- OA Status
- bronze
- Cited By
- 122
- References
- 26
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W2978175710
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W2978175710Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1681/asn.2019040331Digital Object Identifier
- Title
-
Use of Highly Individualized Complement Blockade Has Revolutionized Clinical Outcomes after Kidney Transplantation and Renal Epidemiology of Atypical Hemolytic Uremic SyndromeWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2019Year of publication
- Publication date
-
2019-10-01Full publication date if available
- Authors
-
Julien Zuber, Marie Frimat, Sophie Caillard, Nassim Kamar, Philippe Gatault, Florent Petitprez, Lionel Couzi, Noémie Jourde‐Chiche, Valérie Châtelet, Raphaël Gaisne, Dominique Bertrand, Jamal Bamoulid, Magali Louis, Rébecca Sberro‐Soussan, David Navarro, Pierre‐François Westeel, Luc Frimat, Charlotte Colosio, Antoine Thierry, Joseph Rivalan, Laetitia Albano, Nadia Arzouk, Émilie Cornec-Le Gall, Guillaume Claisse, Michelle Elias, Khalil El Karoui, Sophie Chauvet, Jean‐Philippe Coindre, Jean-Philippe Rérolle, Leïla Tricot, Johnny Sayegh, Cyril Garrouste, Christophe Charasse, Yahsou Delmas, Ziad A. Massy, Maryvonne Hourmant, Aude Servais, Chantal Loirat, Fádi Fakhouri, Claire Pouteil‐Noble, Marie‐Noelle Péraldi, Christophe Legendre, Éric Rondeau, Moglie Le Quintrec, Véronique Frémeaux‐BacchiList of authors in order
- Landing page
-
https://doi.org/10.1681/asn.2019040331Publisher landing page
- PDF URL
-
https://jasn.asnjournals.org/content/jnephrol/30/12/2449.full.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
bronzeOpen access status per OpenAlex
- OA URL
-
https://jasn.asnjournals.org/content/jnephrol/30/12/2449.full.pdfDirect OA link when available
- Concepts
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Eculizumab, Medicine, Atypical hemolytic uremic syndrome, Population, Kidney transplantation, Transplantation, Epidemiology, Cohort, Internal medicine, Retrospective cohort study, Thrombotic microangiopathy, Surgery, Pediatrics, Immunology, Complement system, Disease, Antibody, Environmental healthTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
122Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 14, 2024: 20, 2023: 22, 2022: 28, 2021: 18Per-year citation counts (last 5 years)
- References (count)
-
26Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| corresponding_author_ids | https://openalex.org/A5004808798 |
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| institutions_distinct_count | 45 |
| corresponding_institution_ids | https://openalex.org/I110736937, https://openalex.org/I204730241, https://openalex.org/I4210091437 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
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| sustainable_development_goals[0].display_name | Good health and well-being |
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| citation_normalized_percentile.is_in_top_10_percent | True |