Shiga Toxin–Producing Escherichia coli–Associated Hemolytic Uremic Syndrome in Adult Kidney Transplant Recipients
Year: 2025
Type: article
Study design: Observational Study
Abstract: Introduction: associated hemolytic uremic syndrome (STEC-HUS) is an acquired form of thrombotic microangiopathy (TMA) caused by food and waterborne infection. It remains the leading cause of acute renal injury (AKI) in children. In adults, STEC-HUS is less common but often more severe. Data on STEC-HUS in kidney transplant recipients (KTRs) are limited. Methods: We conducted a retrospective study involving adult KTRs diagnosed with STEC-HUS between January 2012 and April 2022 across 15 French nephrology centers. We aimed to characterize the clinical, biological, and microbiological features of STEC-HUS in this population, its management, and outcomes. Results: A total of 35 adult KTRs were included. The annual incidence was estimated at 14.4 cases per 100,000 KTRs. Six and 29 patients presented with localized intrarenal or systemic TMA, respectively. The median time from transplantation to STEC-HUS diagnosis was 3 (1.2-6.2) years and the mean age at diagnosis was 57 ± 13 years. Neurological and cardiac complications occurred exclusively in patients with systemic TMA. AKI and significant proteinuria were observed in 89% and 94% of patients, respectively. All patients requiring dialysis exhibited systemic TMA (38%). Treatment included azithromycin, eculizumab, and conversion from calcineurin inhibitors (CNIs) to belatacept. Graft loss and mortality rates were 26% and 9%, respectively. Conclusion: posttransplant TMA, whether in the absence of prodromal diarrhea or in localized intra-renal presentations.
Source: Kidney International Reports
Authors: Manal Mazloum, Pierre Trémolières, Nesrine Baili, Cédric Rafat, Hannah Kaminski, Nassim Kamar, Edouard Lefevre, Dominique Bertrand, Charlene Levi, Sophie Chauvet, François Provôt, Roxane Gamot, Pierre-François Westeel, Sophie Caillard, Nicolas Bouvier, Fatouma Touré, Simon Ville, Moglie Le Quintrec, Dany Anglicheau, Rebecca Sberro-Soussan, Frank Martinez, Christophe Legendre, Julien Zuber, Stéphane Bonacorsi, Patricia Mariani, Aurélie Cointe, Anne Scemla
Institutions: Hôpital Necker-Enfants Malades, Assistance Publique – Hôpitaux de Paris, Hôpital Lapeyronie, Centre Hospitalier Régional et Universitaire de Nancy, Hôpital Tenon, Hôpital Pellegrin, Université Toulouse III - Paul Sabatier, Inserm, Hôpital Rangueil, Institut Toulousain des Maladies Infectieuses et Inflammatoires, Bicêtre Hospital, Centre Hospitalier Universitaire de Rouen, Université de Rouen Normandie, Hôpital Edouard Herriot, Hôpital Européen Georges-Pompidou, Centre Hospitalier Universitaire de Lille, Centre Hospitalier Universitaire de Tours, Centre Hospitalier Universitaire Amiens-Picardie, Hôpitaux Universitaires de Strasbourg, Centre Hospitalier Universitaire de Caen Normandie, Université de Caen Normandie, Centre Hospitalier Universitaire de Limoges, Hôpital Universitaire Dupuytren, Centre Hospitalier Universitaire de Nantes, Université Paris Cité, Hôpital Robert-Debré, Infection, Anti-microbiens, Modélisation, Evolution
Language: English
Subfield: Immunology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $2,800
OpenAlex ID: W4413213513