title: Atypical hemolytic uremic syndrome recurrence after kidney transplantation.
abstract: BACKGROUND
  Atypical hemolytic uremic syndrome (aHUS) is a rare disease with a high recurrence rate after kidney transplantation. In most cases, aHUS are caused by genetic mutations of components of the complement alternative pathway. In this single-center series, we present our data of 12 consecutive patients with aHUS and the outcome after kidney transplantation.
  
  
  METHODS
  In this 10-year retrospective study, we identified 12 patients with aHUS who were managed in our center since 2003. We reviewed clinical data, including genetic testing, posttransplant course and response to therapy including the prophylactic use of eculizumab.
  
  
  RESULTS
  Overall, eight patients are women. Six of our patients have at least one genetic mutation causing aHUS, including 4 with complement factor H mutations. Nine patients had at least one previous kidney transplant that failed secondary to recurrent aHUS (75% of our patients). Three patients were treated with eculizumab and plasmapheresis for recurrent aHUS after kidney transplantation; two of them responded to the therapy. Four patients received prophylactic eculizumab; three of them received 6 months and one has been on life long therapy. No signs of recurrence have been observed in these 4 patients so far.
  
  
  CONCLUSIONS
  Genetic mutations of the complement alternative pathway were confirmed in half of our patients, most of those mutations are in CHF. We demonstrate that treatment or prophylaxis with eculizumab was effective in reversing or preventing aHUS whether or not genetic complement mutations were identified.
authors.affiliation: 1 Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD. 2 Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD. 3 Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. 4 Address correspondence to: Nada Alachkar, M.D., Johns Hopkins University School of Medicine, 600 Wolfe Street. Brady 502, Baltimore, MD 21287.
authors.forename: Dany
authors.initials: D
authors.lastname: Matar
authors.forename: Fizza
authors.initials: F
authors.lastname: Naqvi
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Racusen
authors.forename: Naima
authors.initials: N
authors.lastname: Carter-Monroe
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Nada
authors.initials: N
authors.lastname: Alachkar
mesh_terms: D000293:Adolescent; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D065766:Atypical Hemolytic Uremic Syndrome / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D017242:Complement Factor H / Q000235:genetics; D003170:Complement Pathway, Alternative / Q000235:genetics; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010956:Plasmapheresis; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D017242:Complement Factor H; C481642:eculizumab