J Korean Soc Transplant.  1999 Dec;13(2):305-310.

Mycophenolate Mofetil and Prednisolone as Maintenance Therapy in Hemolytic Uremic Syndrome after Kidney Transplantation

• Shin YT
• Jung IM
• Lee KW
• Bae JS

Abstract

Hemolytic uremic syndrome (HUS) after renal transplantation is infrequent but, severe complication of kidney transplantation. Cyclosporine (CyA) or Tacrolimus-induced microangiopathy may be the causative factor in posttransplant HUS. Early diagnosis of the syndrome and discontinuation of cyclosporine or tacrolimus occasionally led to reversal of the syndrome. Many therapeutic trials with variable maintenance immunosuppression protocols were proposed, but, there were no confirmed strategies to manage the posttransplant HUS. We present a case of de novo cyclosporine associated HUS occurring within first a few days after renal transplantation. Early diagnosis was done with presence of shistocytes in peripheral blood smear, thrombocytopenia, low haptoglobin, and renal dysfunction. Supportive therapy with OKT3 immunosuppression followed by mycophenolate mofetil (MMF) and prednisolone (Pds) maintenance therapy led to reversal of renal dysfunction and remission of HUS. In conclusion, in transplant recipients receiving CyA who suffer from HUS, MMF-based dual therapy may be considered. Maintenance treatment with MMF and Pds may be of benefit to more transplant recipients such as those suffering from other CyA or tacrolimus-related side effects.

Keyword

Hemolytic uremic syndrome; Kidney transplantation

MeSH Terms

Cyclosporine
Early Diagnosis
Haptoglobins
Hemolytic-Uremic Syndrome*
Immunosuppression
Kidney Transplantation*
Kidney*
Muromonab-CD3
Prednisolone*
Tacrolimus
Thrombocytopenia
Transplantation
Cyclosporine
Haptoglobins
Muromonab-CD3
Prednisolone
Tacrolimus