title: Outcome of kidney transplants for adults with hemolytic uremic syndrome in the U.S.: a ten-year database analysis.
abstract: BACKGROUND
  There is currently no large study of the U.S. transplant registry comparing the outcome of kidney transplantation for adults with and without hemolytic uremic syndrome (HUS). To date, information on the outcome of transplants for HUS in the U.S. is derived from single or combined-centers studies, but none has been of a nationwide scope.
  
  
  METHODS
  We retrospectively studied a US registry for the outcome of 323 kidney transplants in adults with HUS and of 121,311 transplants in adults with other renal diseases during the period 1999-2009. We analyzed patient, over-all, and death-censored graft survival in the 5 years following transplantation using Kaplan-Meir curves and Cox hazard models.
  
  
  RESULTS
  In the 5 years following kidney transplantation, patient mortality was not significantly different [Hazard Ratio (HR) 1.27, 95% Confidence Interval (CI) 0.78-2.08], but death-censored graft loss was twice as common (HR 2.05, 95% CI 1.53-2.73) for allograft recipients whose native kidney disease was HUS compared to other transplant recipients. The subgroup (n=40 cases) with post-transplant HUS recurrence had a 5-year graft loss rate 5 times that of the subgroup (n=283 cases) without HUS-recurrence (graft survival 14.7% vs.77.4%, log rank 116.5; p<0.001).
  
  
  CONCLUSIONS
  In the largest US series to date of kidney transplants for adults with HUS, 5-year patient survival was not different, but graft outcome was inferior in recipients whose native renal disease were HUS compared to recipients with other kidney diseases. Native kidney HUS is associated with a 2-fold increased risk of death-censored graft loss after kidney transplantation.
authors.affiliation: Department of Medicine, Division of Nephrology, University of Florida, Gainesville, USA.
authors.forename: Alfonso H
authors.initials: AH
authors.lastname: Santos
authors.affiliation: Department of Medicine, Division of Nephrology, University of Florida, Gainesville, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Casey
authors.affiliation: Department of Medicine, Division of Nephrology, University of Florida, Gainesville, USA.
authors.forename: Xuerong
authors.initials: X
authors.lastname: Wen
authors.affiliation: Department of Surgery, Division of Transplantation, University of Florida, Gainesville, USA.
authors.forename: Ivan
authors.initials: I
authors.lastname: Zendejas
authors.affiliation: Former Fellow, Division of Nephrology, University of Florida, Gainesville, USA.
authors.forename: Chirag
authors.initials: C
authors.lastname: Faldu
authors.affiliation: Department of Medicine, Division of Nephrology, University of Florida, Gainesville, USA.
authors.forename: Shehzad
authors.initials: S
authors.lastname: Rehman
authors.affiliation: Department of Surgery, Division of Transplantation, University of Florida, Gainesville, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Andreoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D051799:Delayed Graft Function / Q000401:mortality; D005260:Female; D006084:Graft Rejection / Q000401:mortality; D006085:Graft Survival; D006463:Hemolytic-Uremic Syndrome / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult