Successful treatment of hemolytic uremic syndrome after liver-kidney transplantation

Stefano Gatti, Marcella Arru, Paolo Reggiani, Giovanna Como, Francesca Rossi, Luigi R. Fassati, Claudio Ponticelli

Research output: Contribution to journalArticlepeer-review


Introduction. Hemolytic-uremic syndrome (HUS) is a rare complication in organ transplantation, characterized by hemolytic microangiopathic anemia, thrombocytopenia, and severe renal failure. The syndrome is a well-recognized complication in bone marrow transplantation, and has been likewise described in several cases of solid organs transplantation, but never in patients receiving combined liver and kidney transplantation. Case report. We describe a case of HUS in a 59-year-old woman who underwent combined liver-kidney transplantation for hepato-renal polycystic disease. Clinical and laboratory manifestations of the syndrome were severe and included renal failure, hemolytic anemia, severe thrombocytopenia, hypertension, and neurological damage. The initial treatment consisted of withdrawal of cyclosporine, introduction of low-dose tacrolimus, and administration of fresh frozen plasma (FFP) transfusion and heparin. Since there was no improvement in clinical or biochemical features, plasmapheresis with FTP replacement (2000 mL/day) followed by intravenous immunoglobulin (0.4 mg/Kg/day) was started. A rapid improvement in renal function, platelet count, and hemolytic anemia was observed. Conclusions. Based on the good response observed in our patient, we feel that an aggressive treatment with plasmapheresis and intravenous immunoglobulin should be offered to organ transplant recipients with severe HUS.

Original languageEnglish
Pages (from-to)586-590
Number of pages5
JournalJournal of Nephrology
Issue number4
Publication statusPublished - Jul 2003


  • Combined liver and kidney transplantation
  • Hemolytic uremic syndrome
  • Solid organ transplantation

ASJC Scopus subject areas

  • Nephrology


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