Recurrent complement-mediated Hemolytic uremic syndrome after kidney transplantation

Shota Obata, Frank Hullekes, Leonardo V. Riella, Paolo Cravedi

Research output: Contribution to journalReview articlepeer-review


Hereditary forms of hemolytic uremic syndrome (HUS), formerly known as atypical HUS, typically involve mutations in genes encoding for components of the alternative pathway of complement, therefore they are often referred to as complement-mediated HUS (cHUS). This condition has a high risk of recurrence in the transplanted kidney, leading to accelerated graft loss. The availability of anti-complement component C5 antibody eculizumab has enabled successful transplantation with a notably reduced recurrence rate and improved prognosis. Open questions are related to the potential for complement inhibitor discontinuation, ideal timing of treatment withdrawal, and patient selection based on genetic abnormalities. Our review delves into the pathophysiology, classification, genetic predispositions, and management strategies for cHUS in the native and transplant kidneys.

Original languageEnglish
Article number100857
JournalTransplantation Reviews
Issue number3
StatePublished - Jul 2024


  • Atypical hemolytic uremic syndrome
  • Complement-mediated glomerulonephritis
  • Complement-mediated thrombotic microangiopathy
  • Kidney transplantation
  • Recurrent glomerulonephritis


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