title: Posttransplantation cytomegalovirus-induced recurrence of atypical hemolytic uremic syndrome associated with a factor H mutation: successful treatment with intensive plasma exchanges and ganciclovir.
abstract: 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.
authors.affiliation: Paediatric Nephrology Unit, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Karolien H
authors.initials: KH
authors.lastname: Olie
authors.forename: Timothy H J
authors.initials: TH
authors.lastname: Goodship
authors.forename: René
authors.initials: R
authors.lastname: Verlaak
authors.forename: Sandrine
authors.initials: S
authors.lastname: Florquin
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Groothoff
authors.forename: Lisa
authors.initials: L
authors.lastname: Strain
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Weening
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Davin
mesh_terms: 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
chemical_list: C493495:CFH protein, human; D017242:Complement Factor H; D015774:Ganciclovir