Kidney Transplantation in Patients With Atypical Hemolytic Uremic Syndrome: A Therapeutic Dilemma (or Not)?

Atypical hemolytic uremic syndrome (aHUS) due to genetic and acquired abnormalities of the complement alternative pathway has been associated with high risk for recurrence after kidney transplantation.1 Before the introduction of the anti-C5 monoclonal antibody eculizumab, recurrence was reported in 60% to 80% of aHUS transplant recipients1 and was strongly associated with transplant failure because of the poor response to treatment with plasma exchange.2 Insults resulting from ischemia-reperfusion injury and alloimmune responses, as well as certain immunosuppressive drugs, cause endothelial injury in the transplant and activate complement, thus triggering disease relapse.

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