alexa Development of<em> de novo</em> Hemolytic Uremic Syndrome Post-Transplant and the Role of Donor Specific Antibodies: A Case Report and Review of Literature| Abstract
ISSN 2476-1966

Journal of Immunobiology
Open Access

Like us on:

OMICS International organises 3000+ Global Conferenceseries Events every year across USA, Europe & Asia with support from 1000 more scientific Societies and Publishes 700+ Open Access Journals which contains over 50000 eminent personalities, reputed scientists as editorial board members.

Open Access Journals gaining more Readers and Citations
700 Journals and 15,000,000 Readers Each Journal is getting 25,000+ Readers

This Readership is 10 times more when compared to other Subscription Journals (Source: Google Analytics)
All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.
  • Case Report   
  • J immuno Biol 1: 101,
  • DOI: 10.4172/2476-1966.1000101

Development of de novo Hemolytic Uremic Syndrome Post-Transplant and the Role of Donor Specific Antibodies: A Case Report and Review of Literature

Sean M Wrenn1, Pamela C Gibson2, Donna-Sue Hain2, Sarah Harm2, Paulette B Hammond2, Diti H Shah2, Susan E Hillyard2, Mark Fung2 and Carlos E Marroquin1*
1Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of Vermont College of Medicine, Burlington VT, USA
2Department of Pathology, University of Vermont College of Medicine, Burlington VT, USA
*Corresponding Author : Carlos E Marroquin, Department of Surgery, Division of Transplant and Hepatobiliary Surgery, University of Vermont College of Medicine, South Prospect Street, Burlington , VT 05401, USA, Tel: (802) 847-3619, Fax: (802) 847-3619, Email: [email protected]

Received Date: Oct 27, 2015 / Accepted Date: Oct 30, 2015 / Published Date: Nov 09, 2015

Abstract

Introduction: Hemolytic uremic syndrome (HUS) following kidney transplantation is a devastating complication that may result in substantial morbidity and allograft loss. While calcineurin inhibitor-induced HUS has been well described, anti-donor specific antibody production may be an alternative pathway in the pathogenesis of HUS. We present a case of HUS following kidney transplantation, and will present evidence that donor specific antibodies (DSA) may be a factor in platelet activation and end-organ injury resulting in post-transplant HUS. Case Description: A 66-year-old female with diabetic nephropathy underwent a deceased donor renal transplant with a 5 HLA mismatched kidney. Her immediate course was uneventful with normalization of her creatinine (Cr). She was re-admitted with rising Cr, oliguria, proteinuria, anaemia and thrombocytopenia. A peripheral smear revealed schistocytes, haptoglobin levels were depleted and an allograft biopsy was performed that was suggestive of thrombotic microangiopathy (TMA) with equivocal findings for AMR. Her ADAMTS 13 activity was 103% (normal). She concurrently developed a substantial de novo DSA burden. She underwent therapeutic plasma-pheresis, conversion from tacrolimus to cyclosporine, and received rituximab therapy. She had a complete clinical resolution and remains off of dialysis. Her laboratory markers improved and her antibody titers decreased. Discussion: Post-transplant HUS requires immediate recognition and treatment. This clinical course suggests DSA may be involved in an alternative mechanism of platelet activation leading to HUS and renal insult. Review of the literature suggests this is a rare cause of HUS and we postulate may be under-diagnosed in the transplant population and requires further study.

Keywords: Hemolytic uremic syndrome; Donor specific antibodies; Kidney transplant; Allograft rejection

Citation: Wrenn SM, Gibson PC, Hain DS, Harm S, Hammond PB, et al. (2015) Development of de novo Hemolytic Uremic Syndrome Post-Transplant and the Role of Donor Specific Antibodies: A Case Report and Review of Literature. J immuno Biol 1: 101. Doi: 10.4172/2476-1966.1000101

Copyright: © 2015 Wrenn SM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Select your language of interest to view the total content in your interested language

Post Your Comment Citation
Share This Article
Relevant Topics
Article Usage
  • Total views: 10412
  • [From(publication date): 2-2016 - Sep 21, 2019]
  • Breakdown by view type
  • HTML page views: 10280
  • PDF downloads: 132
Leave Your Message 24x7
Top