Iaria G, Iorio B, Anselmo A, De Luca L, Tariciotti L, Ielpo B, Muzi F, Lucchesi C, D'Andria D, Orlando G, Del Poeta G, Poggi E, Piazza A, Tisone G
Clinica Chirurgica Università Tor Vergata, Ospedale S.Eugenio Roma.
Transplant Proc. 2006 May;38(4):1020-1. doi: 10.1016/j.transproceed.2006.02.019.
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.
溶血尿毒综合征（HUS）是一种严重疾病，其特征为微血管病性溶血性贫血、血小板减少和急性肾衰竭。我们在此报告一名43岁女性患者的病例，该患者于2005年2月因成人起病的HUS接受了第二次尸体肾移植。1996年进行的首次肾移植，因可能的HUS复发，在3周后需要切除移植肾。第二次移植的免疫抑制方案包括巴利昔单抗、他克莫司、霉酚酸酯和类固醇。术后第7天（POD 7），她因急性排斥反应接受类固醇治疗，肾功能有所改善。在POD 19时，由于肾功能恶化，移植肾活检显示HUS复发，因此我们开始进行血液透析，随后进行血浆置换治疗。移植后两个月，由于有HUS的临床证据，患者继续接受血浆置换治疗。在POD 80时，诊断出巨细胞病毒感染，并开始静脉注射更昔洛韦治疗3周。移植110天后，肾功能明显恶化：移植肾肿胀且疼痛，多普勒超声显示肾动脉和静脉通畅，但血流较低。经过2周的血液透析后，患者接受了移植肾切除术。在成人起病的HUS中，复发率会降低移植肾的存活率，尤其是在接受第二次移植的患者中。
