@article{IR,
      school = {M.D.},
      author = {Lerner, Kimberly and Hulme, Rebecca and Shereck, Evan and  Nemecek, Eneida},
      url = {http://digitalcollections.ohsu.edu/record/10034},
      title = {Incidence and outcomes from transplant-associated  thrombotic microangiopathy in pediatric hematopoietic stem  cell transplant recipients before and after the  introduction of Eculizumab},
      publisher = {Oregon Health and Science University},
      abstract = {Transplant-associated thrombotic microangiopathy (TA-TMA)  is a serious complication of hematopoietic stem cell  transplant (HSCT). The introduction of eculizumab, a  complement inhibitor, represented an advancement in the  treatment of TA-TMA and impacted practice at Oregon Health  and Science University (OHSU) since July 2015. In this  study, we performed a retrospective review of pediatric  allogeneic HSCTs occurring between August 2008 -September  2019 at OHSU to describe the incidence of TA-TMA over time  and eculizumab utilization. We used a modified diagnostic  criteria permitting retrospective disease evaluation across  disparate periods. The four criteria defining TA-TMA were  adapted from the Bone Marrow Transplant Clinical Trials  Network 2005 and City of Hope Criteria 2013: 1) Anemia with  schistocytes, 2) LDH > 2x the upper limit of normal, 3)  Serum creatinine > 1.5x baseline, 4) Negative indirect  coombs OR platelets <50 x 109/ml. We found that 17 of 142  patients undergoing HSCT met all four criteria (incidence  12.0%). Of those, 6 out of 85 patients (7%) were identified  between 2008 to 2015 (pre-eculizumab era) while 11 out of  57 patients (19%) were identified between 2015 to 2019  (post-eculizumab era). Patients with TA-TMA were more  likely to be admitted to the pediatric intensive care unit  in the post-eculizumab era (82% vs 24%, P=0.006). TA-TMA  had no significant impact on diagnosis of GVHD. Our single  center experience demonstrated an increased incidence of  TA-TMA since the introduction of eculizumab in 2015 at  OHSU. This increase coincides with an increase in TA-TMA in  non-malignant transplants.},
      number = {IR},
      doi = {https://doi.org/10.6083/9g54xj45n},
      recid = {10034},
      address = {2023},
}