PURPOSE OF REVIEW: Several genetic and acquired abnormalities leading to abnormal activation of the alternative pathway of complement have been identified in patients with atypical hemolytic uremic syndrome (aHUS). The purpose of this review is to shed light on how advances in the understanding of aHUS pathogenesis have impacted on prevention and cure of aHUS recurrence after kidney transplantation. RECENT FINDINGS: Studies over the past decade have shown that the risk of posttransplant recurrence of aHUS depends on the underlying genetic abnormality. The risk is high in patients with mutations in genes encoding circulating complement proteins and regulators, whereas patients with mutations in membrane cofactor protein generally show good transplant outcome. Given the poor outcome associated with recurrence, isolated renal transplantation had been contraindicated in aHUS patients. Combined kidney-liver transplantation and prophylactic plasma exchange have been used to prevent posttransplant recurrences. More recent data have provided evidence about the efficacy of the anti-C5 monoclonal antibody eculizumab in the prevention and treatment of posttransplant aHUS recurrences. SUMMARY: This review summarizes recent advances on preventing and managing aHUS recurrence after kidney transplantation and discusses the issues that still need clarification.
Managing and preventing atypical hemolytic uremic syndrome recurrence after kidney transplantation / M. Noris, G. Remuzzi. - In: CURRENT OPINION IN NEPHROLOGY AND HYPERTENSION. - ISSN 1062-4821. - 22:6(2013), pp. 704-712.
|Titolo:||Managing and preventing atypical hemolytic uremic syndrome recurrence after kidney transplantation|
|Parole Chiave:||anti-C5 monoclonal antibody; atypical hemolytic uremic syndrome; complement; kidney transplantation; recurrence; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal, Murine-Derived; Atypical Hemolytic Uremic Syndrome; Complement Pathway, Alternative; Complement System Proteins; Hemolytic-Uremic Syndrome; Humans; Immunosuppression; Kidney Transplantation; Liver Transplantation; Mutation; Plasma Exchange; Secondary Prevention; Nephrology; Internal Medicine|
|Settore Scientifico Disciplinare:||Settore MED/14 - Nefrologia|
|Data di pubblicazione:||2013|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1097/MNH.0b013e328365b3fe|
|Appare nelle tipologie:||01 - Articolo su periodico|