The Promising Approach in Difficult Atypical Hemolytic Uremic Syndrome Series in Renal Transplantation
1Nephrology, Sisli Memorial Hospital, Istanbul, Turkey
2Nephrology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
3General Surgery, Sisli Memorial Hospital, Istanbul, Turkey
4Urology, Sisli Memorial Hospital, Istanbul, Turkey
5Immunology, Sisli Memorial Hospital, Istanbul, Turkey.
Meeting: 2018 American Transplant Congress
Abstract number: A123
Keywords: Hemolytic-uremic syndrome, Outcome
Session Information
Session Name: Poster Session A: Kidney Acute Antibody Mediated Rejection
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
BACKGROUND:
Atypical hemolytic-uremic syndrome (aHUS) belongs to the group of thrombotic microangiopathies (TMAs), which can recur after renal transplantation if they have been identified as the primary underlying cause of renal failure or may appear de novo post-transplant.
METHODS:
This is a single-center experience about transplantation in patients with aHUS and de novo post-transplant HUS.
RESULTS: Between 2007 and 2017, 1860 patients underwent kidney transplantation at our center. Seven renal transplant recipients with aHUS-related end stage renal disease were transplanted with Eculizumab prophylaxis. Except one patient, others have still been using Eculizumab in variable time-points. The median follow-up time was 28 months. There was no aHUS recurrens, graft and patient loss. Post-transplant de novo HUS appeared in 40 patients. Renal biopsy was done in 16 patients. ABMR was associated with TMA in one patient. When the diagnosis of de novo HUS was made, tacrolimus was switched to Sirolimus (n=34) and plasmapheresis (n=38) was initiated. Sirolimus was reswitched to CNI in 15 patients because of DSA positivity in eight (23.5%) and ABMR in 7 (20.6%) patients. In 3 patients, factor mutations were determined. Eculizumab was given to 6 patients who were resistant to conventional treatment. The median follow-up time was 32.5 months. In patients with post-transplant de novo HUS, seven (17.5%) patients experienced ACR, 8 (20%) ABMR, 11 (27%) DSA positivity, 3 graft loss, and 4 patients were dead. The last median serum creatinine was 1.27mg/dl.
Conclusion:These data confirm that eculizumab is highly effective in preventing posttransplantation aHUS recurrence and may also prevent development ABMR. However, de novo HUS patients who switched to Sirolimus carry high risk to DSA and ABMR development.
CITATION INFORMATION: Yelken B., Gorcin S., Demir E., Karatas C., Arpali E., Akyollu B., Kocak B., Elbasi O., Eksioğlu E., Turkmen A. The Promising Approach in Difficult Atypical Hemolytic Uremic Syndrome Series in Renal Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Yelken B, Gorcin S, Demir E, Karatas C, Arpali E, Akyollu B, Kocak B, Elbasi O, Eksioğlu E, Turkmen A. The Promising Approach in Difficult Atypical Hemolytic Uremic Syndrome Series in Renal Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/the-promising-approach-in-difficult-atypical-hemolytic-uremic-syndrome-series-in-renal-transplantation/. Accessed May 9, 2025.« Back to 2018 American Transplant Congress