Hemolytic uremic syndrome after renal transplantation

Hemolytic Uremic Syndrome after kidney transplantation affects an increasing number of patients. It is characterized as recurrent and de novo. Older age at onset of HUS, shorter mean interval between HUS and transplantation or ESRD, living related donor and treatment with CNI have been associated with an increased risk of recurrence. Patients who lost the first transplant because of HUS recurrence should not receive a second transplant. The outcome of recurring HUS after transplantation is worse in familial forms leading invariably to graft loss and for this reason doctors should discourage the use of living related donors in this setting. De novo HUS is not a rare complication after kidney transplantation and may be associated with infection, CNI or mTOR inhibitor toxicity, antibody use (OKT3), or acute vascular rejection. The clinical picture is obscure and treatment rests on removal of inciting factor with or without plasma exchange/FFP infusion.