Renal transplantation in adults with thrombotic thrombocytopenic purpura/haemolytic-uraemic syndrome.
BACKGROUND
Thrombotic thrombocytopenic purpura/haemolytic-uraemic syndrome (TTP/HUS) is a rare cause of renal failure in adults. There is little data concerning the outcome of adult patients who receive a renal transplant for TTP/HUS:


METHODS
We have carried out a survey of 22 transplant centres in the USA to determine the outcome of patients who developed ESRD from TTP/HUS and latter received a renal transplant.


RESULTS
Twelve of the 22 centres responded to our inquiry. Seven centres had not transplanted any patients with TTP/HUS, and five centres had transplanted a total of 24 grafts in 17 patients with TTP/HUS: Thirty-three per cent of patients demonstrated definite clinical and pathological evidence of recurrence of TTP/HUS: An additional 16% of patients demonstrated pathological evidence of possible recurrence of TTP/HUS in the absence of clinical manifestations. The overall 1-year graft survival rate was 42% and the 2-year graft survival rate was 35%. In our experience recurrence TTP/HUS was associated with universal graft failure. Although cyclosporin A does occasionally cause a thrombotic angiopathy in patients with no history of TTP/HUS, we found no evidence that it should be avoided in patients with a previous history of ESRD from TTP/HUS who subsequently receive a renal transplant.


CONCLUSIONS
TTP/HUS frequently recurres in adults who receive a renal transplant, with a 2-year graft survival rate of 35%.
Conlon
P J
PJ
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Brennan
D C
DC
Pfaf
W W
WW
Finn
W F
WF
Gehr
T
T
Bollinger
R R
RR
Smith
S R
SR
D000328:Adult; D003625:Data Collection; D005260:Female; D006085:Graft Survival; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D011379:Prognosis; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013997:Time Factors; D014481:United States