Table 1 Characteristics of the population according to timing of TMA during post-transplant management

At the time of allograft transplantation

 Previous transplantation, n (%)

23 (30)

9 (38)

7 (23)

7 (32)

0.46

 Primary renal disease

Glomerulonephritis, n (%)

28 (36)

5 (6)

7 (9)

6 (8)

6 (8)

6 (8)

17 (22)

8 (33)

13 (42)

7 (32)

0.72

 Vascular/hypertension, n (%)

3 (13)

0 (0)

2 (9)

0.11

 Obstructive uropathy/reflux nephropathy, n (%)

2 (5)

1 (3)

4 (18)

0.19

 Diabetic nephropathy, n (%)

1 (4)

4 (13)

1 (5)

0.44

 Interstitial nephritis, n (%)

2 (8)

3 (10)

1 (5)

0.88

 Polycystic kidneys, n (%)

2 (8)

2 (6)

2 (9)

0.99

 Unknown, n (%)

6 (25)

8 (26)

5 (23)

0.93

 Anti-HLA class I positivity, n (%)

31 (40)

12 (50)

12 (39)

7 (32)

0.44

 Anti-HLA class II positivity, n (%)

29 (38)

16 (67)

11 (35)

2 (9)

 < 0.001

 Preformed anti-HLA DSA, n (%)

11 (14)

6 (25)

4 (13)

1 (5)

0.10

 Donor age, year, median (IQR)

52 (42–66)

52 (38–72)

58 (46–76)

43 (29–57)

 < 0.05

 Living donor, n (%)

4 (5)

2 (8)

2 (6)

0 (0)

0.55

 Deceased donor, n (%)

73 (95)

22 (92)

29 (94)

22 (100)

0.55

 HLA A, B, mismatch, median (IQR)

3 (2–4)

3.0 (2.2–4.0)

2.5 (2.0–3.2)

3.0 (2.0–3.7)

0.33

 HLA DRB, DQB, mismatch, median (IQR)

2 (1–3)

2.0 (1.2–3.0)

2.0 (1.0–3.0)

1.0 (0.0–2.0)

 < 0.01

 Cold ischemia time, minutes, median (IQR)

932 (708–1158)

869 (634–1094)

957 (773–1120)

1079 (810–1202)

0.53

 Warm ischemia time, minutes, median (IQR)

50 (42–61)

44 (39–56)

48 (42–65)

56 (50–65)

0.16

 Anti-CD25 induction, n (%)

32 (42)

5 (21)

16 (52)

11 (50)

0.04

 Thymoglobulin induction, n (%)

43 (56)

19 (79)

15 (48)

9 (41)

0.02

At the time of TMA diagnosis

 Recipient age, year, median (IQR)

51 (37–67)

48 (33–67)

61 (39–67)

50 (38–66)

0.68

 Women, n (%)

31 (40)

9 (38)

12 (39)

10 (44)

0.84

 Time post-transplantation, days, median (IQR)

954 (8–2695)

3 (1–8)

1079 (182–2257)

3200 (1777–5646)

-

 Previous episode of TMA, n (%)

7 (9)

4 (17)

1 (3)

2 (9)

0.25

History of ABMR, n (%)

-

6 (19)

3 (14)

0.71

 Intensive care unit hospitalization

14 (18)

2 (8)

8 (26)

4 (18)

0.26

 Steroids, n (%)

71 (92)

23 (96)

27 (87)

21 (95)

0.36

 CNI, n (%)

66 (86)

20 (83)

28 (90)

18 (82)

0.71

 mTOR inhibitors, n (%)

7 (9)

1 (4)

5 (16)

1 (5)

0.32

 Mycophenolate mofetil, n (%)

65 (84)

22 (92)

26 (84)

17 (77)

0.42

 Combination of CNI and mTOR inhibitor, n (%)

4 (5)

1 (4)

3 (10)

0 (0)

0.45

Clinical presentation

 Systolic BP, median (IQR)

153 (130–170)

144 (129–168)

148 (130–161)

167 (152–182)

0.44

 Diastolic BP, median (IQR)

85 (70–101)

84 (78–100)

79 (65–90)

101 (84–106)

 < 0,01

 Neurologic symptoms, n (%)

8 (10)

1 (4)

5 (16)

2 (9)

0.37

 Diarrhea, n (%)

16 (21)

1 (4)

10 (32)

5 (23)

0.03

 Purpura, n (%)

3 (4)

1 (4)

1 (3)

1 (5)

1.00

 Fever, n (%)

14 (18)

1 (4)

10 (32)

3 (14)

0.03

 Recurrent herpes zoster, n (%)

1 (1)

0 (0)

0 (0)

1 (5)

0.29

Biological presentation

 Anemia, n (%)

76 (99)

24 (100)

30 (97)

22 (100)

1.00

 Hemoglobin levels, g/dL, median (IQR)

89 (80–98)

8.9 (8.6–9.5)

9.7 (9.1–10.6)

7.7 (6.1–9.3)

 < 0.001

 Mean cell volume, per 1 µm3, median (IQR)

89 (84–94)

90 (86–95)

89 (82–93)

88 (86–93)

0.61

 Presence of schistocytes, n (%)

57 (74)

17 (71)

23 (74)

17 (77)

0.88

 Platelet count < 150.103/µL, n (%)

63 (82)

18 (75)

27 (87)

18 (82)

0.52

 Platelet count, 103/µL, median (IQR)

102 (75–141)

95 (73–160)

113 (76–137)

101 (68–139)

0.95

 Neutropenia, n (%)

17 (22)

5 (21)

11 (35)

1 (5)

0.03

 Lactate dehydrogenase, xUNL, median (IQR)

2 (1.5–2)

2 (1.5–3.0)

2 (1.0–2.0)

2 (2.0–3.0)

0.12

 Lactate dehydrogenase, > UNL, n (%)

59 (77)

19 (79)

21 (68)

19 (86)

0.28

 Low haptoglobin levels, n (%)

62 (81)

22 (92)

21 (68)

19 (86)

0.07

 Fibrinogen, mg/dL, median (IQR)

400 (300–500)

351 (300–586)

375 (296–500)

375 (330–508)

0.81

 C-reactive protein > 10 mg/L, n (%)

38 (49)

14 (58)

14 (45)

10 (45)

0.36

 Donor specific anti-HLA antibody, n (%)

22 (29)

8 (33)

5 (16)

9 (41)

0.12

 Tacrolimus trough level, ng/mL, median (IQR)

8 (5–11)

8.7 (5.1–11.5)

8.0 (6.2–11.9)

4.1 (3.3–7.2)

 < 0.01

 Tacrolimus trough level > 12 ng/mL, n (%)

9 (12)

3 (13)

6 (19)

0 (0)

0.09

 Serum creatinine, µmol/L, median (IQR)

294 (166–510)

266 (137–532)

256 (155–335)

572 (353–783)

 < 0.001

 Proteinuria, n (%)

64 (83)

23 (96)

23 (74)

18 (86)

0.09

 Proteinuria, g/day, median (IQR)

1.6 (0.4–3.4)

1.6 (1.1–3.3)

0.4 (0.2–1.9)

2.5 (1.2–7.0)

 < 0.001