Recurrence of hemolytic uremic syndrome after renal transplantation in children
Recurrence of hemolytic uremic syndrome after renal transplantation in children: a report of the North American Pediatric Renal Transplant Cooperative Study. Quan A, Sullivan EK, Alexander SR. Transplantation 2001;72(4):742-745.
Hemolytic uremic syndrome (HUS) is a leading cause of renal failure in children. Although 90% of children with typical or classic HUS (associated with E. coli O157:H7) fully regain normal renal function, 5% die and 5% develop end-stage renal disease (ESRD) and require subsequent dialysis and renal transplantation. Among HUS renal transplant recipients, the incidence of recurrence of HUS in renal allografts has varied from 0% to 50%. Atypical HUS, use of cyclosporine, and early transplantation after HUS are possible risk factors. This report reviews the data from 61 (54%) of 114 HUS patients within the North American Pediatric Renal Transplant Cooperative Study registry who have had a transplant. Of these 61 patients, 5 patients (with 6 renal transplants) experienced recurrence of HUS within the allograft. Only one of these patients had typical HUS. Cyclosporine was used in three of the six renal allografts with HUS recurrence, whereas none was used in the remaining three. All therapeutic regimens failed to alter the clinical course of recurrent HUS. The time elapsed between onset of ESRD and renal transplantation ranges from 5.5 months to 4.5 years, and the time from transplantation to HUS recurrence ranged from 8 days to about one year. The time from HUS recurrence to graft loss (of two patients with data) was 16-26 days. Five of the six patients with HUS recurrence had graft loss; the patient with two allografts lost both grafts. Other reasons for graft loss were technical difficulties, acute rejection, and chronic rejection. Of the 124 transplants in the 114 HUS patients, 10 transplants were second or third transplants occurring in nine patients. One of these nine patients had HUS recurrences in both transplanted kidneys. Four other retransplanted patients had functioning grafts at the time of follow-up (3.8 years or more) and the remaining patients had graft loss due to primary nonfunction and graft thrombosis. The authors conclude that HUS patients are at risk for experiencing early recurrence of HUS in the allograft within the first month after renal transplantation, particularly with atypical HUS. The use of cyclosporine does not seem to influence the incidence of HUS recurrence, and therapeutic intervention currently does not alter the prognosis of posttransplant HUS.