title: Hemophagocytic syndrome in kidney transplant recipients: report of four cases from a single center.
abstract: BACKGROUND
  The prognosis of hemophagocytic syndrome (HPS) in kidney transplant recipients is reported to be poor, however the optimal therapeutic approach is still unclear.
  
  
  METHODS
  The clinical and follow-up data of the 4 patients with HPS (3 male, 1 female; age 39.7 +/- 11.3 years) among 368 kidney transplant recipients during a 5-year period were retrospectively analyzed.
  
  
  RESULTS
  HPS developed 35-61 days in the post-transplant period. All 4 patients presented with fever. Hepatosplenomegaly and lymphadenopathy were observed only in the first patient. Laboratory tests revealed pancytopenia and hyperferritinemia in all patients, but elevated liver enzymes were observed in 3. Two patients had cytomegalovirus infection, and 1 had Epstein-Barr virus infection. Three patients died despite aggressive supportive therapy, however the fourth case survived after graft nephrectomy.
  
  
  CONCLUSIONS
  HPS pathogenesis in kidney transplants appears to be related with the graft itself. Graft nephrectomy may be the preferable therapeutic approach for kidney transplant recipients with HPS resistant to standard supportive therapy.
authors.affiliation: Akdeniz University Organ Transplantation Center, Antalya, Turkey.
authors.forename: Alihan
authors.initials: A
authors.lastname: Gurkan
authors.forename: Ulkem
authors.initials: U
authors.lastname: Yakupoglu
authors.forename: Asuman
authors.initials: A
authors.lastname: Yavuz
authors.forename: Hilmi
authors.initials: H
authors.lastname: Dikici
authors.forename: Yarkin Kamil
authors.initials: YK
authors.lastname: Yakupoglu
authors.forename: Murat
authors.initials: M
authors.lastname: Tuncer
authors.forename: Alper
authors.initials: A
authors.lastname: Demirbas
authors.forename: Fevzi
authors.initials: F
authors.lastname: Ersoy
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome