Linfohistiocitosis hemofagocítica en trasplante renal

John Fredy Nieto-Ríos, Carol Lisbeth Morales-Contreras, Diana Carolina Chacón-Jaimes, Diego Armando Benavides-Henao, Diana Carolina Bello-Márquez, Lina Maria Serna-Higuita

Resumen


La linfohistiocitosis hemofagocítica (LHH) posterior al trasplante renal hace referencia a un estado hiperinflamatorio grave, asociado a la activación no controlada de los linfocitos T citotóxicos y macrófagos por causa infecciosas y/o secundaria al tratamiento inmunosupresor. Las causas más prevalentes dentro de las infecciones son la histoplasmosis, la tuberculosis y las infecciones por virus herpes. Se caracteriza por fiebre, organomegalias, citopenias, hiperferritinemia, hipertrigliceridemia y/o hipofibrinogenemia; puede acompañarse con hemofagocitosis documentada en la médula ósea, el hígado u otros órganos. Su curso puede ser fulminante con progresión a falla multisistémica y la muerte.

El tratamiento va enfocado a controlar tempranamente la causa desencadenante, reducir la inmunosupresión y controlar la inflamación. En pocos casos es necesario el uso de otros inmunosupresores, quimioterapia o, en situaciones muy seleccionadas, se puede requerir el trasplante de médula ósea.


Palabras clave


Ferritinas; Histoplasmosis; Linfohistiocitosis Hemofagocítica; Trasplante Renal

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Referencias


(1.) Ramachandran S, Zaidi F, Aggarwal A, Gera R. Recent advances in diagnostic and therapeutic guidelines for primary and secondary hemophagocytic lymphohistiocytosis. Blood Cells Mol Dis. 2017;64:53-7. DOI 10.1016/j.bcmd.2016.10.023.

(2.) Karras A. What nephrologists need to know about hemophagocytic syndrome. Nat Rev Nephrol. 2009;5(6):329-36. DOI 10.1038/nrneph.2009.73.

(3.) Otrock ZK, Eby CS. Clinical characteristics, prognostic factors, and outcomes of adult patients with hemophagocytic lymphohistiocytosis. Am J Hematol. 2015;90(3):220-4. DOI 10.1002/ajh.23911.

(4.) Morimoto A, Nakazawa Y, Ishii E. Hemophagocytic lymphohistiocytosis: Pathogenesis, diagnosis, and management. Pediatr Int. 2016;58(9):817-25. DOI 10.1111/ped.13064.

(5.) Esteban YM, de Jong JLO, Tesher MS. An Overview of Hemophagocytic Lymphohistiocytosis. Pediatr Ann. 2017;46(8):e309-e13. DOI 10.3928/19382359-20170717-01.

(6.) Larroche C. Hemophagocytic lymphohistiocytosis in adults: diagnosis and treatment. Joint Bone Spine. 2012;79(4):356-61. DOI 10.1016/j.jbspin.2011.10.015.

(7.) Wysocki CA. Comparing hemophagocytic lymphohistiocytosis in pediatric and adult patients. Curr Opin Allergy Clin Immunol. 2017;17(6):405-13. DOI 10.1097/ACI.0000000000000405.

(8.) Nieto JF, Gomez SM, Moncada DC, Serna LM, Hidron AI. Successful treatment of hemophagocytic lymphohistiocytosis and disseminated intravascular coagulation secondary to histoplasmosis in a patient with HIV/AIDS. Biomedica. 2016;36(0):9-14. DOI 10.7705/biomedica.v36i2.2797.

(9.) Nieto-Ríos JF, Serna-Higuita LM, Guzman-Luna CE, Ocampo-Kohn C, Aristizabal-Alzate A, Ramírez I, et al. Histoplasmosis in renal transplant patients in an endemic area at a reference hospital in Medellin, Colombia. Transplant Proc. 2014;46(9):3004-9. DOI 10.1016/j.transproceed.2014.06.060.

(10.) Nieto-Ríos JF, Aristizabal-Alzate A, Ocampo C, Serrano-Gayubo AK, Serna-Higuita LM, Zuluaga-Valencia G. Disseminated histoplasmosis and haemophagocytic syndrome in two kidney transplant patients. Nefrologia. 2012;32(5):683-4. DOI 10.3265/Nefrologia.pre2012.Jun.11508.

(11.) Filippone EJ, Singh P, Frank AM, Gupta A, Farber JL. Rapidly Fatal Hemophagocytic Lymphohistiocytosis Developing Within Six Days Following Deceased-Donor Renal Transplantation: Case Report. Transplant Proc. 2016;48(9):3123-7. DOI 10.1016/j.transproceed.2016.03.031.

(12.) Yaich S, Charfeddine K, Hsairi D, Zaghdane S, Kammoun K, Makni S, et al. BK virus-associated hemophagocytic syndrome in a renal transplant recipient. Saudi J Kidney Dis Transpl. 2014;25(3):610-4.

(13.) Lehmberg K, Nichols KE, Henter JI, Girschikofsky M, Greenwood T, Jordan M, et al. Consensus recommendations for the diagnosis and management of hemophagocytic lymphohistiocytosis associated with malignancies. Haematologica. 2015;100(8):997-1004. DOI 10.3324/haematol.2015.123562.

(14.) Vega J, Rodriguez M, Goecke H, Santamaria H. Síndrome hemofagocítico en un trasplantado renal con síndrome de Alport. Rev Med Chile. 2013;141:519-24. DOI 10.4067/S0034-8872013000400014.

(15.) Karras A, Thervet E, Legendre C, Groupe Cooperatif de transplantation d’Ile de F. Hemophagocytic syndrome in renal transplant recipients: report of 17 cases and review of literature. Transplantation. 2004;77(2):238-43. DOI 10.1097/01.TP.0000107285.86939.37.

(16.) Marinella MA. Hematologic abnormalities following renal transplantation. Int Urol Nephrol. 2010;42(1):151-64. DOI 10.1007/s11255-009-9558-5.

(17.) Nusshag C, Morath C, Zeier M, Weigand MA, Merle U, Brenner T. Hemophagocytic lymphohistiocytosis in an adult kidney transplant recipient successfully treated by plasmapheresis: A case report and review of the literature. Medicine (Baltimore). 2017;96(50):e9283. DOI 0.1097/MD.0000000000009283.

(18.) Segall L, Moal MC, Doucet L, Kergoat N, Bourbigot B. Toxoplasmosis-associated hemophagocytic syndrome in renal transplantation. Transpl Int. 2006;19(1):78-80. DOI 10.1111/j.1432-2277.2005.00179.x.

(19.) Ardalan MR, Shoja MM, Tubbs RS, Esmaili H, Keyvani H. Postrenal transplant hemophagocytic lymphohistiocytosis and thrombotic microangiopathy associated with parvovirus b19 infection. Am J Transplant. 2008;8(6):1340-4. DOI 10.1111/j.1600-6143.2008.02244.x.

(20.) Lo MM, Mo JQ, Dixon BP, Czech KA. Disseminated histoplasmosis associated with hemophagocytic lymphohistiocytosis in kidney transplant recipients. Am J Transplant. 2010;10(3):687-91. DOI 10.1111/j.1600-6143.2009.02969.x.

(21.) Ponticelli C, Alberighi OD. Haemophagocytic syndrome--a life-threatening complication of renal transplantation. Nephrol Dial Transplant. 2009;24(9):2623-7. DOI 10.1093/ndt/gfp282.

(22.) Daver N, McClain K, Allen CE, Parikh SA, Otrock Z, Rojas-Hernandez C, et al. A consensus review on malignancy-associated hemophagocytic lymphohistiocytosis in adults. Cancer. 2017;123(17):3229-40. DOI 10.1002/cncr.30826.

(23.) Nieto-Rios JF, Gómez de Los Ríos SM, Serna-Higuita LM, Ocampo-Kohn C, Aristizabal-Alzate A, Gálvez-Cárdenas KM, et al. Treatment of post-transplantation lymphoproliferative disorders after kidney transplant with rituximab and conversion to m-TOR inhibitor. Colomb Med. 2016;47(4):196-202.

(24.) Nieto-Rios JF, Gómez de Los Ríos SM, Serna-Higuita LM, Ocampo-Kohn C, Aristizabal-Alzate A, Gálvez-Cárdenas KM, et al. Treatment of post-transplantation lymphoproliferative disorders after kidney transplant with rituximab and conversion to m-TOR inhibitor. Colomb Med. 2016;47(4):196-202.

(25.) Nieto-Ríos JF, Gómez de Los Ríos SM, Serna-Higuita LM, Gálvez-Cardenas KM. Enfermedad linfoproliferativa postrasplante de órgano sólido. Iatreia. 2016;29(3):312-22.

(26.) Hust MA, Blechacz BRA, Bonilla DL, Daver N, Rojas-Hernandez CM. Adult cancer-related hemophagocytic lymphohistiocytosis - a challenging diagnosis: a case report. J Med Case Rep. 2017;11(1):172. DOI 10.1186/s13256-017-1344-x.

(27.) Wakefield C, Mehta PA, Corathers S, Geller J, Gelfand M, Olowokure O, et al. A First Report of Secondary Hemophagocytic Lymphohistiocytosis Associated With Papillary Thyroid Carcinoma. J Pediatr Hematol Oncol. 2018;40(2):e97-e8. DOI 10.1097/MPH.0000000000000991.

(28.) Satzger I, Ivanyi P, Langer F, Kreipe HH, Schaper-Gerhardt K, Beutel G, et al. Treatment-related hemophagocytic lymphohistiocytosis secondary to checkpoint inhibition with nivolumab plus ipilimumab. Eur J Cancer. 2018;93:150-3. DOI 10.1016/j.ejca.2018.01.063.

(29.) Janka GE, Lehmberg K. Hemophagocytic syndromes--an update. Blood Rev. 2014;28(4):135-42. DOI 10.1016/j.blre.2014.03.002.

(30.) Voskoboinik I, Smyth MJ, Trapani JA. Perforin-mediated target-cell death and immune homeostasis. Nat Rev Immunol. 2006;6(12):940-52. DOI 10.1038/nri1983.

(31.) Filippone EJ, Farber JL. Hemophagocytic lymphohistiocytosis: an update for nephrologists. Int Urol Nephrol. 2016;48(8):1291-304. DOI 10.1007/s11255-016-1294-z.

(32.) Weaver LK, Behrens EM. Hyperinflammation, rather than hemophagocytosis, is the common link between macrophage activation syndrome and hemophagocytic lymphohistiocytosis. Curr Opin Rheumatol. 2014;26(5):562-9. DOI 10.1097/BOR.0000000000000093.

(33.) Weaver LK, Behrens EM. Weathering the storm: Improving therapeutic interventions for cytokine storm syndromes by targeting disease pathogenesis. Curr Treatm Opt Rheumatol. 2017;3(1):33-48. DOI 10.1007/s40674-017-0059-x.

(34.) Canna SW, Behrens EM. Making sense of the cytokine storm: a conceptual framework for understanding, diagnosing, and treating hemophagocytic syndromes. Pediatr Clin North Am. 2012;59(2):329-44. DOI 10.1016/j.pcl.2012.03.002.

(35.) De Saint Basile G, Menasche G, Fischer A. Molecular mechanisms of biogenesis and exocytosis of cytotoxic granules. Nat Rev Immunol. 2010;10(8):568-79. DOI 10.1038/nri2803.

(36.) Thiery J, Keefe D, Boulant S, Boucrot E, Walch M, Martinvalet D, et al. Perforin pores in the endosomal membrane trigger the release

f endocytosed granzyme B into the cytosol of target cells. Nat Immunol. 2011;12(8):770-7. DOI 10.1038/ni.2050.

(37.) Marsh RA. Epstein-Barr Virus and Hemophagocytic Lymphohistiocytosis. Front Immunol. 2017;8:1902. DOI 10.3389/fimmu.2017.01902.

(38.) Arlet JB, Le TH, Marinho A, Amoura Z, Wechsler B, Papo T, et al. Reactive haemophagocytic syndrome in adult-onset Still’s disease: a report of six patients and a review of the literature. Ann Rheum Dis. 2006;65(12):1596-601. DOI 10.1136/ard.2005.046904.

(39.) Esmaili H, Mostafidi E, Mehramuz B, Ardalan M, Mohajel-Shoja M. An update on renal involvement in hemophagocytic syndrome (macrophage activation syndrome). J Nephropathol. 2016;5(1):8-4. DOI 10.15171/jnp.2016.02.

(40.) Thaunat O, Delahousse M, Fakhouri F, Martinez F, Stephan JL, Noel LH, et al. Nephrotic syndrome associated with hemophagocytic syndrome. Kidney Int. 2006;69(10):1892-8. DOI 10.1038/sj.ki.5000352.

(41.) Al-Lamki RS, Mayadas TN. TNF receptors: signaling pathways and contribution to renal dysfunction. Kidney Int. 2015;87(2):281-6. DOI 10.1038/sj.ki.5000352.

(42.) Allen CE, Yu X, Kozinetz CA, McClain KL. Highly elevated ferritin levels and the diagnosis of hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2008;50(6):1227-35. DOI 10.1002/pbc.21423.

(43.) Lehmberg K, McClain KL, Janka GE, Allen CE. Determination of an appropriate cut-off value for ferritin in the diagnosis of hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2014;61(11):2101-3. DOI 10.1002/pbc.25058.

(44.) Otrock ZK, Daver N, Kantarjian HM, Eby CS. Diagnostic Challenges of Hemophagocytic Lymphohistiocytosis. Clin Lymphoma Myeloma Leuk. 2017;17S:S105-S10. DOI 10.1016/j.clml.2017.02.017.

(45.) George MR. Hemophagocytic lymphohistiocytosis: review of etiologies and management. J Blood Med. 2014;5:69-86. DOI 10.2147/JBM.S46255.

(46.) Henter JI, Horne A, Arico M, Egeler RM, Filipovich AH, Imashuku S, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer. 2007;48(2):124-31. DOI 10.1002/pbc.21039.

(47.) Asci G, Toz H, Ozkahya M, Cagirgan S, Duman S, Sezis M, et al. High-dose immunoglobulin therapy in renal transplant recipients with hemophagocytic histiocytic syndrome. J Nephrol. 2006;19(3):322-6.

(48.) Caselli D, Arico M, Party EPW. The role of BMT in childhood histiocytoses. Bone Marrow Transplant. 2008;41 Suppl 2:S8-S13. DOI 10.1038/bmt.2008.46.

(49.) Lin S, Li Y, Long J, Liu Q, Yang F, He Y. Acute liver failure caused by hemophagocytic lymphohistiocytosis in adults: A case report and review of the literature. Medicine (Baltimore). 2016;95(47):e5431. DOI 10.1097/MD.0000000000005431.

(50.) Pastula DM, Burish M, Reis GF, Bollen A, Cha S, Ralph J, et al. Adult-onset central nervous system hemophagocytic lymphohistiocytosis: a case report. BMC Neurol. 2015;15:203. DOI 10.1186/s12883-015-0470-6

(51.) Machaczka M, Vaktnas J, Chiang SC, Bryceson YT. Alemtuzumab treatment for hemophagocytic lymphohistiocytosis. Nat Rev Clin Oncol. 2010;7(10). DOI 10.1038/nrclinonc.2010.40-c1.




DOI: https://doi.org/10.17533/udea.iatreia.21 Resumen : 109 PDF : 21

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