Characteristics and Outcomes of Renal Transplant Recipients with Hemolytic Uremic Syndrome in the United States

Bekir Tanriover; Ronak Lakhia; Yu Min Shen; Burhaneddin Sandikci; Ramesh Saxena; Malcolm MacConmara; Abigail A. Soyombo; Nilum Rajora; Mark A. Hardy

doi:10.1097/TXD.0000000000000555

Characteristics and Outcomes of Renal Transplant Recipients with Hemolytic Uremic Syndrome in the United States

Bekir Tanriover^*, Ronak Lakhia, Yu Min Shen, Burhaneddin Sandikci, Ramesh Saxena, Malcolm MacConmara, Abigail A. Soyombo, Nilum Rajora, Mark A. Hardy

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background. Hemolytic uremic syndrome (HUS) accounts for less than 1% of renal transplants in the United States. There are limited data on the characteristics and outcomes of HUS in pediatric and adult kidney transplant recipients in the United States. Methods. This study included all renal transplant recipients identified with HUS (N = 1233) as a cause of end-stage renal disease between 1987 and 2013 using the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. The cohort was divided into 2 age groups: pediatric (N = 447) and adult (N = 786). Main outcomes were acute rejection rate at 1 year, allograft and patient survival, and recurrence of HUS posttransplant. Both age groups were then compared with a propensity score (PS) (1:2 ratio) matched control group with an alternative primary kidney disease (non-HUS cohort: pediatric [N = 829] and adult [N = 1547]). Results. In pediatric cohort, when compared with the PS-matched controls, acute rejection, death censored allograft, and patient survival was similar in the HUS group. However, in the adult cohort, the graft and patient survivals were significantly worse in the HUS group. The HUS was associated with allograft loss (hazard ratio, 1.40, 95% confidence interval, 1.14-1.71) in adult recipients. Patients with HUS recurrence had significantly lower allograft and patient survival rates compared with the nonrecurrent group in both age groups. Acute rejection was one of the major predictor of HUS recurrence in adults (odds ratio, 2.64; 95% confidence interval, 1.25-5.60). Calcineurin inhibitors were not associated HUS recurrence in both age groups. Conclusions. Pediatric HUS patients, unlike adult recipients, have similar outcomes compared with the PS-matched controls. Recurrence of HUS is associated with poor allograft and patient survivals in pediatric and adult patients. Use of calcineurin inhibitors seem to be safe as a part of maintenance immunosuppression posttransplantation. A comprehensive national registry is urgently needed.

Original language	English
Article number	e41
Journal	Transplantation Direct
Volume	1
Issue number	10
DOIs	https://doi.org/10.1097/TXD.0000000000000555
Publication status	Published - 1 Nov 2015
Externally published	Yes

Bibliographical note

Publisher Copyright:
Copyright © 2015 The Authors.

Funding

Supported, in part, by NIH T32HL007854-19 (MAH) and T32-DK007257 (LR). Based on OPTN data as of September 30, 2013, this work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

Funders	Funder number
U.S. Government
National Institutes of Health	T32HL007854-19, T32-DK007257
U.S. Department of Health and Human Services
Health Resources and Services Administration	234-2005-370011C

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/TXD.0000000000000555

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@article{5b670e1c47d14244ac395da7b27394b1,

title = "Characteristics and Outcomes of Renal Transplant Recipients with Hemolytic Uremic Syndrome in the United States",

abstract = "Background. Hemolytic uremic syndrome (HUS) accounts for less than 1% of renal transplants in the United States. There are limited data on the characteristics and outcomes of HUS in pediatric and adult kidney transplant recipients in the United States. Methods. This study included all renal transplant recipients identified with HUS (N = 1233) as a cause of end-stage renal disease between 1987 and 2013 using the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. The cohort was divided into 2 age groups: pediatric (N = 447) and adult (N = 786). Main outcomes were acute rejection rate at 1 year, allograft and patient survival, and recurrence of HUS posttransplant. Both age groups were then compared with a propensity score (PS) (1:2 ratio) matched control group with an alternative primary kidney disease (non-HUS cohort: pediatric [N = 829] and adult [N = 1547]). Results. In pediatric cohort, when compared with the PS-matched controls, acute rejection, death censored allograft, and patient survival was similar in the HUS group. However, in the adult cohort, the graft and patient survivals were significantly worse in the HUS group. The HUS was associated with allograft loss (hazard ratio, 1.40, 95% confidence interval, 1.14-1.71) in adult recipients. Patients with HUS recurrence had significantly lower allograft and patient survival rates compared with the nonrecurrent group in both age groups. Acute rejection was one of the major predictor of HUS recurrence in adults (odds ratio, 2.64; 95% confidence interval, 1.25-5.60). Calcineurin inhibitors were not associated HUS recurrence in both age groups. Conclusions. Pediatric HUS patients, unlike adult recipients, have similar outcomes compared with the PS-matched controls. Recurrence of HUS is associated with poor allograft and patient survivals in pediatric and adult patients. Use of calcineurin inhibitors seem to be safe as a part of maintenance immunosuppression posttransplantation. A comprehensive national registry is urgently needed.",

author = "Bekir Tanriover and Ronak Lakhia and Shen, {Yu Min} and Burhaneddin Sandikci and Ramesh Saxena and Malcolm MacConmara and Soyombo, {Abigail A.} and Nilum Rajora and Hardy, {Mark A.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2015 The Authors.",

year = "2015",

month = nov,

day = "1",

doi = "10.1097/TXD.0000000000000555",

language = "English",

volume = "1",

journal = "Transplantation Direct",

issn = "2373-8731",

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TY - JOUR

T1 - Characteristics and Outcomes of Renal Transplant Recipients with Hemolytic Uremic Syndrome in the United States

AU - Tanriover, Bekir

AU - Lakhia, Ronak

AU - Shen, Yu Min

AU - Sandikci, Burhaneddin

AU - Saxena, Ramesh

AU - MacConmara, Malcolm

AU - Soyombo, Abigail A.

AU - Rajora, Nilum

AU - Hardy, Mark A.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Background. Hemolytic uremic syndrome (HUS) accounts for less than 1% of renal transplants in the United States. There are limited data on the characteristics and outcomes of HUS in pediatric and adult kidney transplant recipients in the United States. Methods. This study included all renal transplant recipients identified with HUS (N = 1233) as a cause of end-stage renal disease between 1987 and 2013 using the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. The cohort was divided into 2 age groups: pediatric (N = 447) and adult (N = 786). Main outcomes were acute rejection rate at 1 year, allograft and patient survival, and recurrence of HUS posttransplant. Both age groups were then compared with a propensity score (PS) (1:2 ratio) matched control group with an alternative primary kidney disease (non-HUS cohort: pediatric [N = 829] and adult [N = 1547]). Results. In pediatric cohort, when compared with the PS-matched controls, acute rejection, death censored allograft, and patient survival was similar in the HUS group. However, in the adult cohort, the graft and patient survivals were significantly worse in the HUS group. The HUS was associated with allograft loss (hazard ratio, 1.40, 95% confidence interval, 1.14-1.71) in adult recipients. Patients with HUS recurrence had significantly lower allograft and patient survival rates compared with the nonrecurrent group in both age groups. Acute rejection was one of the major predictor of HUS recurrence in adults (odds ratio, 2.64; 95% confidence interval, 1.25-5.60). Calcineurin inhibitors were not associated HUS recurrence in both age groups. Conclusions. Pediatric HUS patients, unlike adult recipients, have similar outcomes compared with the PS-matched controls. Recurrence of HUS is associated with poor allograft and patient survivals in pediatric and adult patients. Use of calcineurin inhibitors seem to be safe as a part of maintenance immunosuppression posttransplantation. A comprehensive national registry is urgently needed.

AB - Background. Hemolytic uremic syndrome (HUS) accounts for less than 1% of renal transplants in the United States. There are limited data on the characteristics and outcomes of HUS in pediatric and adult kidney transplant recipients in the United States. Methods. This study included all renal transplant recipients identified with HUS (N = 1233) as a cause of end-stage renal disease between 1987 and 2013 using the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. The cohort was divided into 2 age groups: pediatric (N = 447) and adult (N = 786). Main outcomes were acute rejection rate at 1 year, allograft and patient survival, and recurrence of HUS posttransplant. Both age groups were then compared with a propensity score (PS) (1:2 ratio) matched control group with an alternative primary kidney disease (non-HUS cohort: pediatric [N = 829] and adult [N = 1547]). Results. In pediatric cohort, when compared with the PS-matched controls, acute rejection, death censored allograft, and patient survival was similar in the HUS group. However, in the adult cohort, the graft and patient survivals were significantly worse in the HUS group. The HUS was associated with allograft loss (hazard ratio, 1.40, 95% confidence interval, 1.14-1.71) in adult recipients. Patients with HUS recurrence had significantly lower allograft and patient survival rates compared with the nonrecurrent group in both age groups. Acute rejection was one of the major predictor of HUS recurrence in adults (odds ratio, 2.64; 95% confidence interval, 1.25-5.60). Calcineurin inhibitors were not associated HUS recurrence in both age groups. Conclusions. Pediatric HUS patients, unlike adult recipients, have similar outcomes compared with the PS-matched controls. Recurrence of HUS is associated with poor allograft and patient survivals in pediatric and adult patients. Use of calcineurin inhibitors seem to be safe as a part of maintenance immunosuppression posttransplantation. A comprehensive national registry is urgently needed.

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U2 - 10.1097/TXD.0000000000000555

DO - 10.1097/TXD.0000000000000555

M3 - Article

AN - SCOPUS:85045213341

SN - 2373-8731

VL - 1

JO - Transplantation Direct

JF - Transplantation Direct

IS - 10

M1 - e41

ER -

Characteristics and Outcomes of Renal Transplant Recipients with Hemolytic Uremic Syndrome in the United States

Abstract

Bibliographical note

Funding

UN SDGs

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