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Long-term outcomes of thrombotic microangiopathy treated with plasma exchange: A systematic review.
Thejeel, Bashiar; Garg, Amit X; Clark, William F; Liu, Aiden R; Iansavichus, Arthur V; Hildebrand, Ainslie M.
Afiliación
  • Thejeel B; Schulich School of Medicine, Western University, London, Ontario, Canada.
  • Garg AX; Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.
  • Clark WF; Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.
  • Liu AR; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
  • Iansavichus AV; Division of Nephrology, Western University, London, Ontario, Canada.
  • Hildebrand AM; Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.
Am J Hematol ; 91(6): 623-30, 2016 06.
Article en En | MEDLINE | ID: mdl-26910131
With the adoption of plasma exchange as standard treatment for thrombotic microangiopathy (TMA), more patients are surviving and long-term outcomes have greater relevance. We conducted a systematic review to synthesize and evaluate the quality of evidence on long-term outcomes of TMA among adults treated with plasma exchange and to identify factors that may be associated with a worse long-term prognosis. We searched databases from 1980 to 2013 for eligible articles published in any language. We included studies that reported outcomes in at least ten adults with a history of TMA treated with plasma exchange and at least 6 months of follow-up. We abstracted data in duplicate and assessed the methodological quality of each study using an assessment tool developed based on recommended validity criteria. We screened 6672 articles, reviewed 213, and included 34 studies totaling 1182 patients (study median [range], 24 [10-118]). The mean (or median) follow-up ranged from 6 months to 13 years. The cumulative incidence of relapse and mortality was highly variable and ranged from 3 to 84 and 0 to 61%, respectively. The incidence of other outcomes across 10 studies also varied (outcomes included hypertension, kidney disease, preeclampsia, stroke, seizure, severe cognitive impairment, and depression); in three other studies, long-term neurocognitive function and health-related quality of life were significantly lower than in the general population. Patients who survive an episode of TMA may be susceptible to long-term vascular complications, but the magnitude of this risk and how to mitigate it remains unclear. Am. J. Hematol. 91:623-630, 2016. © 2016 Wiley Periodicals, Inc.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Intercambio Plasmático / Microangiopatías Trombóticas Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Aspecto: Patient_preference Límite: Humans Idioma: En Revista: Am J Hematol Año: 2016 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Intercambio Plasmático / Microangiopatías Trombóticas Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Aspecto: Patient_preference Límite: Humans Idioma: En Revista: Am J Hematol Año: 2016 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos