Received May 31, 2005
Accepted on August 5, 2005

Original Articles

Outcome of Renal Transplantation in Patients with Non-Shiga Toxin-Associated Hemolytic Uremic Syndrome: Prognostic Significance of Genetic Background

Elena Bresin ^*, Erica Daina ^*1, Marina Noris ^*, Federica Castelletti ^*, Rumen Stefanov , Prudence Hill , Timothy H.J. Goodship , Giuseppe Remuzzi ^*, and for the International Registry of Recurrent and Familial HUS/TTP

*Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases Aldo e Cele Daccò, Ranica, Bergamo, Italy; Department of Social Medicine and Health Management, Medical University of Plovdiv, Plovdiv, Bulgaria; Department of Anatomical Pathology, St. Vincent’s Hospital, Victoria, Australia; and Institute of Human Genetics and Department of Nephrology, University of Newcastle upon Tyne, Newcastle, United Kingdom

¹ To whom correspondence should be addressed. E-mail: daina{at}marionegri.it.

	Abstract

More than 50% of patients with non-Shiga toxin-associated hemolytic uremic syndrome (non-Stx-HUS) progress to ESRD. Kidney transplant failure for disease recurrence is common; hence, whether renal transplantation is appropriate in this clinical setting remains a debated issue. The aim of this study was to identify possible prognostic factors for renal transplant outcome by focusing on specific genetic abnormalities associated with the disease. All articles in literature that describe renal transplant outcome in patients with ESRD secondary to non-Stx-HUS, genotyped for CFH, MCP, and IF mutations, were reviewed, and data of patients who were referred to the International Registry of Recurrent and Familial HUS/TTP and data from the Newcastle cohort were examined. This study confirmed that the overall outcome of kidney transplantation in patients with non-Stx-HUS is poor, with disease recurring in 60% of patients, 91.6% of whom developed graft failure. No clinical prognostic factor that could identify patients who were at high risk for graft failure was found. The presence of a factor H (CFH) mutation was associated with a high incidence of graft failure (77.8 versus 54.9% in patients without CFH mutation). Similar results were seen in patients with a factor I (IF) mutation. In contrast, graft outcome was favorable in all patients who carried a membrane co-factor protein (MCP) mutation. Patients with non-Stx-HUS should undergo genotyping before renal transplantation to help predict the risk for graft failure. It is debatable whether a kidney transplant should be recommended for patients with CFH or IF mutation. Reasonably, patients with an MCP mutation can undergo a kidney transplant without risk for recurrence.