Humar A, Jessurun J, Sharp H L, Gruessner R W
Department of Surgery, University of Minnesota, Delaware St. S.E., Minneapolis, MN 55455, USA.
Transpl Int. 1999;12(5):387-90. doi: 10.1007/s001470050245.
Post-transplant hemolytic uremic syndrome (HUS) is an uncommon but well-described complication in solid organ transplant recipients. Believed to be secondary to immunosuppressive therapy, it has been reported after kidney, liver, pancreas, heart, and lung transplants. In all reported cases, the primary organ affected was the kidney (transplant or native). But until now, no cases after small-bowel transplants and no cases in which the kidney was not the primary organ affected have been reported. We report two cases of HUS in small-bowel transplant recipients. In our first case, clinical presentation was with renal failure; biopsy of the native kidney demonstrated the typical histological changes seen with HUS, namely occlusion of the microcirculation by thrombi and platelet aggregation. Immunosuppression was changed from tacrolimus to cyclosporin, but with no improvement in renal function. In our second case, the transplanted bowel was the primary organ affected. This recipient presented with ulcers in the bowel mucosa, which were believed to be ischemic in origin, secondary to occlusive vascular lesions affecting the small vessels in the transplanted bowel. Her tacrolimus dose was decreased with resolution of ulcers and no evidence of rejection. These two cases represent the first reports of HUS after small-bowel transplants; in addition, our second case represents the first report of an extrarenal graft as the primary organ affected. When caring for small-bowel transplant recipients, physicians must be alert to the possibility of HUS and its various presentations.
移植后溶血性尿毒症综合征（HUS）是实体器官移植受者中一种罕见但已有充分描述的并发症。据信它继发于免疫抑制治疗，在肾、肝、胰、心和肺移植后均有报道。在所有报道的病例中，受影响的主要器官是肾脏（移植肾或自身肾）。但截至目前，尚未报道小肠移植后发生的病例，也没有报道肾脏不是主要受影响器官的病例。我们报告了两例小肠移植受者发生HUS的病例。在我们的第一例病例中，临床表现为肾衰竭；对自身肾进行活检显示出HUS典型的组织学变化，即血栓和血小板聚集导致微循环阻塞。免疫抑制药物从他克莫司改为环孢素，但肾功能没有改善。在我们的第二例病例中，移植的小肠是主要受影响器官。该受者出现肠黏膜溃疡，据信其起源为缺血性，继发于影响移植小肠小血管的闭塞性血管病变。随着溃疡的消退且无排斥反应迹象，她的他克莫司剂量减少。这两例病例代表了小肠移植后HUS的首例报道；此外，我们的第二例病例代表了首例以外肾移植物作为主要受影响器官的报道。在护理小肠移植受者时，医生必须警惕HUS及其各种表现的可能性。
