Recurrence of Hemolytic-Uremic Syndrome in Renal Transplant Recipients

Abstract

Risk factors for HUS recurrence in renal transplantation could be identified through this meta-analysis.

45: Recurrent Atypical Hemolytic Uremic Syndrome Associated With Factor I Mutation in a Living Related Renal Transplant Recipient

“…Prior to genetic testing for aHUS, multiple studies showed recurrence of disease in the recipient together with the appearance of de novo aHUS in the donor. [20][21][22][23][24] On this basis, if a living-related donor transplantation is considered, the donor and recipient should have complete molecular testing of CFH, CFI, CD46 and CFB. In the absence of mutations in these genes or if a deletion of CFHR1 and CFHR3 is found, screening should include circulating autoantibodies for CFH and peripheral blood mononuclear cell CD46 expression.…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…The overall rate of recurrence for HUS was 28% (342). One-year graft survival was 33% compared to 77% in controls (342). Older age of onset of HUS, shorter interval between HUS onset and transplantation, shorter interval between HUS onset and ESRD, the use of living donors and the use of calcineurin inhibitors were all associated with recurrence (342).…”

“…There was no difference in the rate of recurrence between first or second transplants. In multivariate analysis, age at onset of HUS, interval between HUS and ESRD, use of calcineurin inhibitors, and living-related donors were statistically significant predictors of HUS (342). The risk for graft failure in patients with posttransplant HUS/ thrombotic thrombocytopenic purpura (TTP) was reported to be 5.4 higher than for patients without posttransplant HUS/ TTP (271).…”

“…In the meta-analysis there were 159 grafts in 127 patients with ESRD from hemolytic uremic syndrome (HUS), although data on risk factors were available for only about half of these patients (342). The overall rate of recurrence for HUS was 28% (342).…”

“…Cyclosporine (342), tacrolimus (343), anti-lymphocyte globulin (344) and OKT3 (345) have each been reported to be associated with recurrence of HUS after transplantation in case reports and small uncontrolled series. A recent multiKasiske et al Rationale Anti-GBM disease can recur in renal allografts, although the incidence of recurrence is not high enough to preclude transplantation.…”