Dany Matar1, Fizza Naqvi, Lorraine C Racusen, Naima Carter-Monroe, Robert A Montgomery, Nada Alachkar. 1. 1 Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD. 2 Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD. 3 Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. 4 Address correspondence to: Nada Alachkar, M.D., Johns Hopkins University School of Medicine, 600 Wolfe Street. Brady 502, Baltimore, MD 21287.
Abstract
BACKGROUND: Atypical hemolytic uremic syndrome (aHUS) is a rare disease with a high recurrence rate after kidney transplantation. In most cases, aHUS are caused by genetic mutations of components of the complement alternative pathway. In this single-center series, we present our data of 12 consecutive patients with aHUS and the outcome after kidney transplantation. METHODS: In this 10-year retrospective study, we identified 12 patients with aHUS who were managed in our center since 2003. We reviewed clinical data, including genetic testing, posttransplant course and response to therapy including the prophylactic use of eculizumab. RESULTS: Overall, eight patients are women. Six of our patients have at least one genetic mutation causing aHUS, including 4 with complement factor H mutations. Nine patients had at least one previous kidney transplant that failed secondary to recurrent aHUS (75% of our patients). Three patients were treated with eculizumab and plasmapheresis for recurrent aHUS after kidney transplantation; two of them responded to the therapy. Four patients received prophylactic eculizumab; three of them received 6 months and one has been on life long therapy. No signs of recurrence have been observed in these 4 patients so far. CONCLUSION: Genetic mutations of the complement alternative pathway were confirmed in half of our patients, most of those mutations are in CHF. We demonstrate that treatment or prophylaxis with eculizumab was effective in reversing or preventing aHUS whether or not genetic complement mutations were identified.
BACKGROUND:Atypical hemolytic uremic syndrome (aHUS) is a rare disease with a high recurrence rate after kidney transplantation. In most cases, aHUS are caused by genetic mutations of components of the complement alternative pathway. In this single-center series, we present our data of 12 consecutive patients with aHUS and the outcome after kidney transplantation. METHODS: In this 10-year retrospective study, we identified 12 patients with aHUS who were managed in our center since 2003. We reviewed clinical data, including genetic testing, posttransplant course and response to therapy including the prophylactic use of eculizumab. RESULTS: Overall, eight patients are women. Six of our patients have at least one genetic mutation causing aHUS, including 4 with complement factor H mutations. Nine patients had at least one previous kidney transplant that failed secondary to recurrent aHUS (75% of our patients). Three patients were treated with eculizumab and plasmapheresis for recurrent aHUS after kidney transplantation; two of them responded to the therapy. Four patients received prophylactic eculizumab; three of them received 6 months and one has been on life long therapy. No signs of recurrence have been observed in these 4 patients so far. CONCLUSION: Genetic mutations of the complement alternative pathway were confirmed in half of our patients, most of those mutations are in CHF. We demonstrate that treatment or prophylaxis with eculizumab was effective in reversing or preventing aHUS whether or not genetic complement mutations were identified.
Authors: Neetika Garg; Yuzhou Zhang; Anne Nicholson-Weller; Eliyahu V Khankin; Nicolò Ghiringhelli Borsa; Nicole C Meyer; Susan McDermott; Isaac E Stillman; Helmut G Rennke; Richard J Smith; Martha Pavlakis Journal: Nephrol Dial Transplant Date: 2018-12-01 Impact factor: 5.992
Authors: Leonardo Caroti; Giuseppe Cestone; Lorenzo Di Maria; Marco Allinovi; Vicenzo Li Marzi; Sergio Serni; Calogero Lino Cirami Journal: Clin Nephrol Case Stud Date: 2021-05-25