Reeling in complement in transplant‐associated thrombotic microangiopathy: You're going to need a bigger boat

Abstract

AbstractOver the last decade there have been numerous advances in both the diagnosis and treatment of transplant‐associated thrombotic microangiopathy (TA‐TMA). These are largely the result of an improved understanding of complement activation in TA‐TMA and the ability to prevent end organ injury and death with timely initiation of complement‐blocking therapies. In this article, we review our current understanding of the pathophysiology of TA‐TMA, particularly as it pertains to complement activation, endothelial injury, and clinical management. We then review novel complement‐blocking therapies that are currently under investigation for use in TA‐TMA, as well as discuss special considerations for complement‐blocking therapy in hematopoietic stem cell transplant recipients. Through these reviews we aim to answer or at least provide an educated discussion on the most commonly posed TA‐TMA management questions and dilemmas.