[Hemolytic-uremic syndrome following kidney transplantation: prognostic factors]

Posttransplant hemolytic uremic syndrome (P-HUS) is a rare complication following kidney transplantation and is due to thrombotic microangiopathy. The aim of the present study was to determine patients at risk for this condition and to describe the follow-up in patients who developed P-HUS. The study is based on 557 consecutive patients who underwent either renal or combined renal and pancreatic transplantation in the cyclosporin era. P-HUS occurred in 19 out of 557 patients (3.4%). The reasons for developing P-HUS were: vascular rejection in 10 patients, association with cyclosporin in 5 patients, recurrence of an original HUS in 3 patients, and a transplanted shock-damaged kidney in 1 case. Patients with retransplants, grafts procured from non-heartbeating donors, high levels of anti-HLA antibodies, high HLA-DR mismatch, and HUS or Alport syndrome as the original disease, were found to be at increased risk for developing P-HUS. One-year graft survival for the P-HUS group was 42% and 88% for patients without this complication. Despite full therapy the prognosis of a P-HUS remains poor. Therefore, prevention of P-HUS, which consists in avoidance of the combination of the risk factors mentioned above, is emphasised.