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Shiga toxin-associated hemolytic uremic syndrome: absence of recurrence after renal transplantation

Shiga toxin-associated hemolytic uremic syndrome: absence of recurrence after renal transplantation. Ferraris JR, Ramirez JA, Ruiz S, Caletti MG, Vallejo G, Piantanida JJ, Araujo JL, Sojo ET. Pediatric Nephrology 2002;17:809-814.

ABSTRACT:

This study assessed the relationship between the acute phase of Shiga toxin-associated hemolytic uremic syndrome (Stx-HUS) and the development of end-stage renal disease (ESRD) among pediatric renal transplant patients in Argentina. Stx-HUS patients were compared to those with other diseases (controls) in a 20-year retrospective study. Among the 62 patients with Stx-HUS, the mean age at onset of Stx-HUS was three years in the group who did not recover renal function in the acute phase while the mean age at onset for the children with temporary recovery of renal function was one year, a statistically significant difference. The interval between the end of the acute phase and ESRD was 9 years; most of the children progressed to ESRD within 6-18 years. Longer duration of oliguria was associated with a shorter interval in reaching ESRD. None of the children had recurrence of disease during the follow-up period. After renal transplantation, there were no significant differences between Stx-HUS patients and those with other diseases in terms of renal function and frequency of acute and accelerated rejection of the kidney transplant. The number of acute rejections decreased significantly in the Stx-HUS group compared to the control group with the addition of cyclosporine. Similar results were found with chronic rejection. Graft survival in Stx-HUS patients was significantly greater than in the control group. In those Stx-HUS patients with early ESRD, graft survival was 85% at 10 years. Patient survival did not differ between the two groups, with 92% of Stx-HUS patients vs. 83% of controls surviving at 15 years after transplantation.