Shiga toxin-associated hemolytic uremic syndrome: absence of recurrence after renal transplantation.
We evaluated the relationship between the acute phase and the development of end-stage renal disease (ESRD) and the outcome of renal transplant in patients with Shiga toxin-associated hemolytic uremic syndrome (Stx-HUS). A 20-year retrospective study was performed of 66 renal transplants in 62 patients with Stx-HUS compared with 189 renal allografts in 178 children with other diseases. Of 62 patients, 61 had >7 days of oliguria during the acute phase. Stx-HUS patient survival was not different from controls (92% vs. 83% 15 years after renal transplantation). In the cyclosporine (CsA) era, survival of grafts from living related (LRD) and cadaver (CD) donors in Stx-HUS and control patients was 83% versus 70% ( P<0.03) and 77% versus 49% ( P<0.05) at 10 years. Graft survival in Stx-HUS and dysplasia/obstructive uropathy patients was 79% versus 76% ( P=NS), but it was different from that of other diseases (79% vs. 58%, P<0.001). There was no clinical or histopathological evidence of Stx-HUS recurrence. In conclusion, in Stx-HUS patients the duration of the acute oliguric period was a good predictor for the progression to ESRD. Use of CsA and the absence of recurrence of the disease influenced the excellent prognosis in Stx-HUS patients after renal transplantation. The development of ESRD in Stx-HUS could be mediated by non-immunological factors.
Ferraris
Jorge R
JR
Department of Pediatrics, Hospital Italiano, Buenos Aires, Argentina. jferraris@ intramed.net.ar
Ramirez
Jose A
JA
Ruiz
Susana
S
Caletti
María G
MG
Vallejo
Graciela
G
Piantanida
Juan J
JJ
Araujo
Jose L
JL
Sojo
Ernesto T
ET
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006463:Hemolytic-Uremic Syndrome / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000473:pathology / Q000601:surgery; D016030:Kidney Transplantation / Q000502:physiology*; D019520:Living Donors; D008297:Male; D012008:Recurrence; D022621:Shiga Toxin; D016896:Treatment Outcome
D022621:Shiga Toxin