Posttransplantation cytomegalovirus-induced recurrence of atypical hemolytic uremic syndrome associated with a factor H mutation: successful treatment with intensive plasma exchanges and ganciclovir.
Atypical hemolytic uremic syndrome (HUS) can recur after renal transplantation and often leads to graft loss. In some series of familial HUS, the risk of early graft loss due to recurrence of HUS approaches 100% despite any therapy. This led some authors to claim that kidney transplantation is contraindicated in those patients. The authors describe an 8-year-old girl with end-stage renal failure owing to familial atypical HUS with a factor H mutation who underwent successful transplantation using continuous prophylactic plasma exchange (PE). Twenty-four months after transplantation, plasma creatinine level is 1.2 mg/dL (106 micromol/L) despite 2 recurrences of HUS contemporaneous to 2 cytomegalovirus infections, which resolved with PE intensification and ganciclovir. This strongly suggests that cytomegalovirus infection may trigger posttransplant recurrent HUS. The feasibility of kidney transplantation in case of atypical HUS related to factor H mutation using continuous prophylactic PE intensified during relapses should be confirmed in prospective studies.
Olie
Karolien H
KH
Paediatric Nephrology Unit, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
Goodship
Timothy H J
TH
Verlaak
René
R
Florquin
Sandrine
S
Groothoff
Jaap W
JW
Strain
Lisa
L
Weening
Jan J
JJ
Davin
Jean-Claude
JC
D002648:Child; D017242:Complement Factor H / Q000235:genetics*; D003587:Cytomegalovirus / Q000187:drug effects / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology* / Q000235:genetics / Q000628:therapy*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D009154:Mutation / Q000235:genetics*; D010951:Plasma Exchange / Q000379:methods*; D012008:Recurrence
C493495:CFH protein, human; D017242:Complement Factor H; D015774:Ganciclovir