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Outcomes of renal transplant in patients with anti-complement factor H antibody-associated hemolytic uremic syndrome.
- Source :
-
Pediatric transplantation [Pediatr Transplant] 2014 Aug; Vol. 18 (5), pp. E134-9. Date of Electronic Publication: 2014 May 12. - Publication Year :
- 2014
-
Abstract
- Atypical HUS associated with anti-CFH autoantibodies is an uncommon illness associated with high risk of progression to end-stage renal disease. Disease relapses after transplantation, observed in one-third cases, often lead to graft loss. We report four patients with anti-CFH antibody-associated HUS who underwent renal transplantation 16-62 months from initial presentation. Two patients each received organs from deceased and living-related donors. Anti-CFH antibody titers were monitored during the illness and following transplantation. All patients received two doses of IV rituximab before or after transplantation; three patient each received 1-2 g/kg of IV immunoglobulin or underwent 2-5 sessions of plasma exchanges. The use of therapeutic plasma exchange, IV immunoglobulin, and rituximab in two cases enabled two-third reduction in anti-CFH antibody titers before transplantation. At 5- to 26-month follow-up, all patients showed satisfactory graft function without recurrence of HUS. This is the first report of patients with anti-CFH antibody-associated HUS who underwent living-related renal transplantation. Clearance of anti-CFH antibody by therapeutic plasma exchange and adjuvant immunosuppression aimed at decreasing antibody levels may enable successful transplantation and recurrence-free survival.<br /> (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Subjects :
- Adolescent
Antibodies, Monoclonal, Murine-Derived therapeutic use
Child
Humans
Immunosuppressive Agents therapeutic use
Male
Plasma Exchange methods
Recurrence
Renal Insufficiency surgery
Rituximab
Time Factors
Treatment Outcome
Autoantibodies blood
Complement Factor H immunology
Hemolytic-Uremic Syndrome immunology
Hemolytic-Uremic Syndrome therapy
Immunoglobulins, Intravenous therapeutic use
Kidney Transplantation
Subjects
Details
- Language :
- English
- ISSN :
- 1399-3046
- Volume :
- 18
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Pediatric transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 24814615
- Full Text :
- https://doi.org/10.1111/petr.12273