Eculizumab for atypical hemolytic uremic syndrome recurrence in renal transplantation

J. Zuber, M. Le Quintrec, S. Krid, C. Bertoye, V. Gueutin, A. Lahoche, N. Heyne, G. Ardissino, V. Chatelet, L. H. Noël, M. Hourmant, P. Niaudet, V. Frémeaux-Bacchi, E. Rondeau, C. Legendre, C. Loirat

Research output: Contribution to journalArticlepeer-review


Eculizumab (anti-C5) has been sporadically reported as an efficient therapy for atypical hemolytic uremic syndrome (aHUS). However, the lack of series precludes any firm conclusion about the optimal use of anti-C5 for preventing or treating aHUS posttransplant aHUS recurrence. We thoroughly studied 22 renal transplant recipients with aHUS who received off-label therapy with anti-C5, including 12 cases, which have not been reported yet. Nine patients, all carrying a complement genetic abnormality associated with a high risk of aHUS recurrence, received prophylactic anti-C5 therapy to prevent posttransplant recurrence. Eight of them had a successful recurrence-free posttransplant course and achieved a satisfactory graft function, while the remaining patient experienced early arterial thrombosis of the graft. Thirteen renal transplant recipients were given anti-C5 for posttransplant aHUS recurrence. A complete reversal of aHUS activity was obtained in all of them. Importantly, the delay of anti-C5 initiation after the onset of the aHUS episode inversely correlated with the degree of renal function improvement. Three patients in whom anti-C5 was subsequently stopped experienced a relapse. Altogether these data suggest that long-term eculizumab is highly effective for preventing and treating posttransplant aHUS recurrence. Our study also indicates that anti-C5 should be promptly started if a recurrence occurs.

Original languageEnglish
Pages (from-to)3337-3354
Number of pages18
JournalAmerican Journal of Transplantation
Issue number12
Publication statusPublished - Dec 2012


  • Atypical hemolytic uremic syndrome
  • eculizumab
  • renal transplant recipient

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)


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