Renal transplantation in patients with hemolytic uremic syndrome: high rate of recurrence and increased incidence of acute rejections.
BACKGROUND
The reported outcome of renal transplantation in patients with the hemolytic uremic syndrome (HUS) varies greatly, probably related to the diverse causes of HUS. In this single-center retrospective study, we have analyzed the recurrence rate, the incidence of acute rejections, and graft survival in patients suffering from adult-onset and childhood-onset HUS.


METHODS
The medical records of 35 patients with end-stage renal disease caused by HUS, who received 50 renal allografts, were reviewed. A definite recurrence of HUS was diagnosed if both clinical and histologic signs of thrombotic microangiopathy (TMA) were present in the absence of any endovasculitis. If there were signs of mild endovasculitis, a probable recurrence was diagnosed.


RESULTS
After first renal transplantation, 0 definite and 1 (6%) probable recurrence occurred in 18 patients with childhood-onset HUS, as opposed to 7 (41%) definite and 3 (18%) probable recurrences in 17 adult-onset HUS patients (odds ratio [OR], 13.4; 95% confidence interval [CI], 1.7-105.7). In the latter patients, early use of cyclosporine A increased the risk for recurrence. The incidence of acute rejections was increased compared with matched controls (OR, 1.52; 95% CI, 1.05-2.19 for adult-onset HUS and OR, 1.88; 95% CI, 1.34-2.62 for childhood-onset HUS). One-year graft survival in adult-onset HUS was poor (29%), whereas 1-year graft survival in childhood-onset HUS was comparable to matched controls.


CONCLUSIONS
In adult-onset HUS, the recurrence rate and the incidence of acute rejections are high, resulting in a detrimental graft survival. In childhood-onset HUS, the recurrence rate is low, but the posttransplantation course is complicated by an increased incidence of acute rejections.
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003181:Complement C4 / Q000032:analysis; D015935:Complement C4b; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006463:Hemolytic-Uremic Syndrome / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007668:Kidney / Q000737:chemistry / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors
D003181:Complement C4; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d