Eculizumab Successfully Rescues Against de novo Atypical Hemolytic Uremic Syndrome Following Retransplantation

Kidney transplantation has emerged as the optimal treatment for end-stage renal disease. However, the occurrence of atypical hemolytic uremic syndrome (aHUS) following renal transplantation is extremely uncommon and associated with adverse outcomes, often resulting in early graft loss, thus warranting heightened awareness. This report details a case of successful management of a patient who developed post-transplant aHUS following retransplantation. The patient had previously suffered graft failure shortly after the first kidney transplantation due to unexplained non-rejection mechanisms. Following the second transplantation, the individual presented with new-onset anemia, thrombocytopenia, acute kidney injury, and elevated lactate dehydrogenase levels within a short time frame, all manifesting undetermined etiology. A comprehensive assessment of dynamic changes in hemoglobin, platelet count, serum creatinine, and lactate dehydrogenase, alongside pathological examinations, culminated in a definitive diagnosis of aHUS. After undergoing four treatments with eculizumab, there was a sustained improvement in hemoglobin, platelet count, serum creatinine, and lactate dehydrogenase levels, thereby preserving the function of the transplanted kidney. Timely diagnosis and early application of eculizumab in treating aHUS are crucial. Furthermore, comprehensive pre-transplant evaluations of patients to exclude aHUS risk factors are essential.