The
hemolytic uremic syndrome (HUS) is a severe disease characterized by
microangiopathic hemolytic anemia,
thrombocytopenia, and
acute renal failure. We herein report our experience with a 43-year-old female patient who underwent a second cadaveric
kidney transplantation in February 2005, for adult-onset HUS. The first
renal transplantation, which was performed in 1996, required removal after 3 weeks for probable recurrence of HUS. The immunosuppressive regimen for the second transplant included
basiliximab,
tacrolimus,
mycophenolate mofetil, and
steroids. On postoperative day (POD) 7, she received
steroid treatment for an acute rejection episode with improved renal function. On POD 19 due to worsening renal function, a graft biopsy showed HUS recurrence, thus we instituted
hemodialysis and then
plasmapheresis treatments. At two months after
transplantation, the patient continued under
plasmapheresis treatment due to clinical evidence of HUS. On POD 80,
cytomegalovirus infection was diagnosed and intravenous
gancyclovir treatment started for 3 weeks. After 110 days from transplant, a deterioration in renal function was evident: the graft was swollen and painful with Doppler ultrasound showing patency of both the renal artery and vein but, low blood flow. After 2 weeks of
hemodialysis, the patient underwent transplantectomy. In adult-onset HUS the recurrence rate reduces graft survival, particularly among patients undergoing second
transplantation.