Nephrology Dialysis Transplantation, Vol 12, Issue 7 1425-1430, Copyright © 1997 by Oxford University Press
RB Miller, BA Burke, WJ Schmidt, KJ Gillingham, AJ Matas, M Mauer and CE Kashtan
BACKGROUND: The incidence of recurrence of haemolytic-uraemic syndrome
(HUS) in renal allografts appears to vary by centre, with the highest rates
reported from the University of Minnesota. It is possible that the high
rate of HUS recurrence at this institution reflects a transplant population
skewed towards patients with a form of HUS that is more likely to recur in
the allograft. METHODS: This study examined whether the initial episode of
HUS in the native kidneys was preceded by a diarrhoeal prodrome ('classical
HUS') or not ('atypical HUS'), and evaluated transplant outcomes in 24
patients who received 36 transplants at the University of Minnesota between
31 May 1972 and 31 December 1994. RESULTS: Eighteen of the 24 patients had
atypical HUS, three had classical HUS, and in three patients the presence
or absence of a diarrhoeal prodrome could not be determined. Recurrent HUS,
defined as microangiopathic haemolytic anaemia, thrombocytopenia, renal
insufficiency, and allograft biopsy findings compatible with HUS, occurred
16 times in 14 grafts in 11 patients. Nine of these patients had atypical
HUS, one had classical HUS, and in one the nature of the prodrome could not
be determined. Eleven of the 14 initial recurrences took place within 2
months of transplant. Recurrence was not more frequent in patients who
received cyclosporin or antilymphocyte preparations. Actuarial analysis
using matched controls showed poorer graft survival in patients with a
primary diagnosis of HUS (P = 0.007), due to the high frequency of graft
loss in HUS patients with recurrence. CONCLUSION: Based upon these data and
a review of the literature, it can be concluded that the risk of recurrence
of HUS in the allograft is confined almost entirely to patients with
atypical forms of HUS.
ORIGINAL ARTICLES
Recurrence of haemolytic-uraemic syndrome in renal transplants: a single-centre report
University of Minnesota, Department of Pediatrics, Minneapolis 55455, USA.
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