title: Successful treatment of hemolytic uremic syndrome after liver-kidney transplantation.
abstract: BACKGROUND
  Hemolytic-uremic syndrome (HUS) is a rare complication in organ transplantation, characterized by hemolytic microangiopathic anemia, thrombocytopenia, and severe renal failure. The syndrome is a well-recognized complication in bone marrow transplantation, and has been likewise described in several cases of solid organs transplantation, but never in patients receiving combined liver and kidney transplantation.
  
  
  METHODS
  We describe a case of HUS in a 59-year-old woman who underwent combined liver-kidney transplantation for hepato-renal polycystic disease. Clinical and laboratory manifestations of the syndrome were severe and included renal failure, hemolytic anemia, severe thrombocytopenia, hypertension, and neurological damage. The initial treatment consisted of withdrawal of cyclosporine, introduction of low-dose tacrolimus, and administration of fresh frozen plasma (FFP) transfusion and heparin. Since there was no improvement in clinical or biochemical features, plasmapheresis with FFP replacement (2000 mL/day) followed by intravenous immunoglobulin (0.4 mg/Kg/day) was started. A rapid improvement in renal function, platelet count, and hemolytic anemia was observed.
  
  
  CONCLUSIONS
  Based on the good response observed in our patient, we feel that an aggressive treatment with plasmapheresis and intravenous immunoglobulin should be offered to organ transplant recipients with severe HUS.
authors.affiliation: Liver Transplant Unit, IRCCS Maggiore Hospital, Milan, Italy. stefanogatti@everyday.com
authors.forename: Stefano
authors.initials: S
authors.lastname: Gatti
authors.forename: Marcella
authors.initials: M
authors.lastname: Arru
authors.forename: Paolo
authors.initials: P
authors.lastname: Reggiani
authors.forename: Giovanna
authors.initials: G
authors.lastname: Como
authors.forename: Francesca
authors.initials: F
authors.lastname: Rossi
authors.forename: Luigi R
authors.initials: LR
authors.lastname: Fassati
authors.forename: Claudio
authors.initials: C
authors.lastname: Ponticelli
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous