Singh N, Gayowski T, Marino I R
Infectious Disease Section, VA Medical Center, Pittsburgh, PA 15240, USA.
Transpl Int. 1996;9(1):68-75. doi: 10.1007/BF00336815.
Post-transplant hemolytic uremic syndrome characterized by microangiopathic hemolysis, thrombocytopenia, and renal failure is an infrequent but potentially serious complication in organ transplant recipients. Hemolytic uremic syndrome developed in 2% (2/100) of our consecutive liver transplants. We report our patients and review a total of 91 cases of hemolytic uremic syndrome in adult solid organ transplant recipients reported in the literature. Ninety percent were observed in renal transplant recipients, 8% in liver, and 1% each in lung and heart transplant recipients. Eighty percent and 96% of cases occurred within 90 days and 1 year, respectively, post-transplantation. In renal transplant recipients, 23% of cases were due to post-transplant recurrence of hemolytic uremic syndrome. In 50% of renal transplant recipients and in all nonrenal solid-organ transplant recipients, hemolytic uremic syndrome was attributed to cyclosporin or tacrolimus therapy. Notably, infections were not a significant precipitating factor for post-transplant hemolytic uremic syndrome. Graft loss attributable to hemolytic uremic syndrome occurred in 43% of renal transplant recipients while renal transplantation and hemodialysis were required in the lung and heart transplant recipients due to hemolytic uremic syndrome induced renal failure. The overall mortality was 13% (12/91). Physicians caring for transplant recipients need to be aware of this potentially severe graft and life-threatening disorder since prompt recognition and removal of identifiable risk factors is critical in the management of post-transplant hemolytic uremic syndrome.
移植后溶血性尿毒症综合征以微血管病性溶血、血小板减少和肾衰竭为特征，是器官移植受者中一种罕见但可能严重的并发症。在我们连续进行的肝移植中，2%（2/100）发生了溶血性尿毒症综合征。我们报告了我们的患者，并回顾了文献中报道的成年实体器官移植受者中总共91例溶血性尿毒症综合征病例。90%见于肾移植受者，8%见于肝移植受者，肺和心脏移植受者各占1%。分别有80%和96%的病例发生在移植后90天内和1年内。在肾移植受者中，23%的病例是由于溶血性尿毒症综合征移植后复发。在50%的肾移植受者以及所有非肾实体器官移植受者中，溶血性尿毒症综合征归因于环孢素或他克莫司治疗。值得注意的是，感染不是移植后溶血性尿毒症综合征的重要诱发因素。43%的肾移植受者因溶血性尿毒症综合征导致移植物丢失，而肺和心脏移植受者因溶血性尿毒症综合征诱发的肾衰竭需要进行肾移植和血液透析。总体死亡率为13%（12/91）。照顾移植受者的医生需要意识到这种潜在的严重移植物和危及生命的疾病，因为及时识别和消除可识别的危险因素对于移植后溶血性尿毒症综合征的管理至关重要。
