title: Characteristics and Outcomes of Renal Transplant Recipients with Hemolytic Uremic Syndrome in the United States.
abstract: BACKGROUND
  Hemolytic uremic syndrome (HUS) accounts for <1% of renal transplants in the US. There are limited data on the characteristics and outcomes of HUS in pediatric and adult kidney transplant recipients in the US.
  
  
  METHODS
  This study included all renal transplant recipients identified with HUS (N=1,233) as a cause of end-stage renal disease between 1987 and 2013 using the UNOS/OPTN database. The cohort was divided into two age groups: pediatric (N=447) and adult (N=786). Main outcomes were acute rejection rate at one-year, allograft and patient survival, and recurrence of HUS post-transplant. Both age groups were then compared with a propensity score (1:2 ratio) matched control group with an alternative primary kidney disease (non-HUS cohort: pediatric [N= 829] and adult [N=1,547]).
  
  
  RESULTS
  In pediatric cohort, when compared to the PS matched controls, acute rejection, death censored allograft and patient survival was similar in the HUS group. However, in the adult cohort, the graft and patient survivals were significantly worse in the HUS group. HUS was associated with allograft loss (HR=1.40, 95%CI 1.14-1.71) in adult recipients. Patients with HUS recurrence had significantly lower allograft and patient survival rates compared to the non-recurrent group in both age groups. Acute rejection was one of the major predictor of HUS recurrence in adults (OR=2.64, 95%CI 1.25-5.60). Calcineurin inhibitors (CNI) were not associated HUS recurrence in both age groups.
  
  
  CONCLUSIONS
  Pediatric HUS-patients, unlike adult recipients, have similar outcomes compared to the PS matched controls. Recurrence of HUS is associated with poor allograft and patient survival in pediatric and adult patients. Use of CNIs seem to be safe as a part of maintenance immunosuppression post-transplantation. A comprehensive national registry is urgently needed.
authors.affiliation: Division of Nephrology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Bekir
authors.initials: B
authors.lastname: Tanriover
authors.affiliation: Division of Nephrology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Ronak
authors.initials: R
authors.lastname: Lakhia
authors.affiliation: Division of Hematology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Yu-Min
authors.initials: YM
authors.lastname: Shen
authors.affiliation: Booth School of Business, University of Chicago, IL.
authors.forename: Burhaneddin
authors.initials: B
authors.lastname: Sandikci
authors.affiliation: Division of Nephrology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Saxena
authors.affiliation: Department of Surgery, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Malcolm
authors.initials: M
authors.lastname: MacConmara
authors.affiliation: Division of Nephrology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Abigail A
authors.initials: AA
authors.lastname: Soyombo
authors.affiliation: Division of Nephrology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Nilum
authors.initials: N
authors.lastname: Rajora
authors.affiliation: Department of Surgery, Columbia University College of Physicians & Surgeons, New York, NY.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hardy