Renal transplantation in patients with hemolytic uremic syndrome: high rate of recurrence
Renal transplantation in patients with hemolytic uremic syndrome: high rate of recurrence and increased incidence of acute rejections. Artz MA, Steenbergen EJ, Hoitsma AJ, Monnens LAH, Wetzels JFM. Transplantation 2003;76(5):821-826.
Approximately 5% to 15% of patients with hemolytic uremic syndrome (HUS) develop end-stage renal disease (ESRD). Renal transplantation is the preferred treatment for patients with ESRD although the reported outcome of transplantation in patients with HUS has varied greatly. This Dutch study of 35 patients with HUS-associated ESRD assessed the recurrence of HUS after first renal transplantation and the incidence of acute rejection. Among the 18 children studied, 28% had diarrhea-associated HUS, 33% were not associated with diarrhea, and another 39% had unknown causes although the authors thought it most likely that in these patients HUS was also diarrhea-associated. In these 18 patients, no definite recurrence of HUS developed after renal transplantation, although in one case, a recurrence was considered probable. The odds of developing an acute rejection were nearly twice that of controls. One year graft survival was 78%. In five children, a second renal transplantation and in two patients a third transplantation was performed, without any recurrence of HUS. In contrast, adult-onset HUS had a high recurrence rate and the incidence of acute rejections was high, resulting in a detrimental graft survival.