title: Case series: hemolytic uremic syndrome--another cause of transplant dysfunction.
abstract: BACKGROUND
  Renal transplantation is the optimal treatment for suitable patients with end-stage renal disease (ESRD). However, acute graft dysfunction occurs in 5%-35% of patients. This is commonly due to acute rejection, drug toxicity, ureteric obstruction, or infection. Atypical hemolytic uremic syndrome (aHUS), either recurrent or de novo, is uncommon after transplantation.
  
  
  METHODS
  We highlight three cases of acute transplant dysfunction in which transplant biopsy revealed HUS without associated clinical or hematologic clues to the etiology. Two cases had recurrent HUS and 1 had de novo HUS secondary to tacrolimus therapy. Screenings for ADAMTS-13 and gene mutations of complement regulatory proteins were negative. Thrombocytopenia and red blood cell fragments on blood film appeared some days later.
  
  
  METHODS
  Treatment comprised a combination of plasma exchange with fresh-frozen plasma and switching immunosuppressive therapy, which led to the recovery of the above hematologic features but salvaged graft function in only 1 case.
  
  
  CONCLUSIONS
  Classical hematologic findings of HUS appeared late in these cases. HUS should be considered in cases of allograft dysfunction where there is no obvious cause, and biopsy should be performed. This enables early initiation of therapy to gain rapid recovery of hematologic parameters and potentially of transplant function.
authors.forename: M N
authors.initials: MN
authors.lastname: Ali
authors.affiliation: Department of Renal Medicine, Hull and East Yorkshire Hospitals, NHS Trust, and Hull and York Medical School, Hull, East Yorkshire, United Kingdom.
authors.forename: M N A
authors.initials: MN
authors.lastname: Ali
authors.forename: A
authors.initials: A
authors.lastname: Syed
authors.forename: A B
authors.initials: AB
authors.lastname: Syed
authors.forename: S
authors.initials: S
authors.lastname: Bhandari
authors.forename: S C
authors.initials: SC
authors.lastname: Bhandari
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000503:physiopathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation; D008297:Male; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus