Journal article
Tailored eculizumab therapy in the management of complement factor H-mediated atypical hemolytic uremic syndrome in an adult kidney transplant recipient: a case report
Transplantation proceedings, Vol.44(10), pp.3037-3040
12/2012
DOI: 10.1016/j.transproceed.2012.07.141
PMID: 23195022
Abstract
Atypical hemolytic uremic syndrome (aHUS) is characterized by thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury (AKI) which frequently progresses to end-stage renal disease (ESRD). In 50% of affected patients, mutations in complement regulatory proteins cause inappropriate complement activation with endothelial injury. Complement factor H (CFH) mutations cause 25% of aHUS cases; these patients have an 80% recurrence risk after kidney transplantation. Eculizumab, an anti-C5 antibody, is effective in limiting hemolysis episodes in patients with aHUS, but less is known about preventing recurrence after kidney transplantation. Herein we report the use of prophylactic eculizumab in an adult with aHUS who underwent kidney transplantation. A 31-year-old female presented with aHUS and progressive AKI associated with low complement 3 level leading to ESRD despite plasmapheresis and corticosteroids. She had a heterozygous nonsense mutation in CFH and reduced plasma CFH levels. She was given preoperative plasmapheresis and eculizumab and underwent living unrelated renal transplantation. Postoperatively, eculizumab was dosed to achieve low functional complement 5 levels and low soluble membrane attack complex levels and she has maintained excellent graft function without aHUS recurrence. We propose that eculizumab with titrated dosing should be used in CFH-mediated aHUS patients who are at a high risk of recurrence.
Details
- Title: Subtitle
- Tailored eculizumab therapy in the management of complement factor H-mediated atypical hemolytic uremic syndrome in an adult kidney transplant recipient: a case report
- Creators
- L Xie - Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USAC M NesterA I ReedY ZhangR J SmithC P Thomas
- Resource Type
- Journal article
- Publication Details
- Transplantation proceedings, Vol.44(10), pp.3037-3040
- DOI
- 10.1016/j.transproceed.2012.07.141
- PMID
- 23195022
- NLM abbreviation
- Transplant Proc
- ISSN
- 0041-1345
- eISSN
- 1873-2623
- Publisher
- United States
- Language
- English
- Date published
- 12/2012
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Molecular Physiology and Biophysics; Anatomy and Cell Biology; Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Accounting; Surgery; Obstetrics and Gynecology; Otolaryngology; Internal Medicine
- Record Identifier
- 9983985903102771
Metrics
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