HUS and Kidney Transplantation
Kidney transplants result in better lifestyle, longer survival, and better health for HUS patients.
The goal for patients with end-stage renal disease (ESRD) secondary to HUS is a renal transplant. It results in a better lifestyle, longer survival, and better health than does dialysis. This certainly applies for those whose ESRD is due to D+HUS. In contrast to atypical (non-Shiga toxin) HUS, those with classic D+HUS rarely experience recurrent disease in their renal graft.
Transplant is not a “cure”, however, and should not be viewed as such. A renal transplant (renal graft) rarely lasts for a lifetime and several transplants should be anticipated. If the patient has been followed and monitored during the course of progressive renal failure, and if a related living donor (LRD) is available, the transplant can be timed to occur just as the patient is entering end-stage renal disease (ESRD) and is known as a pre-emptive transplant. If not, the patient begins dialysis and is put on the waiting list.
Children receive special consideration for renal transplant and do not have to wait as long adults. Many factors determine the anticipated waiting time for a cadaveric transplant, but the major one is the patients’ ABO blood type. Even though a few centers are now doing transplants across ABO blood groups, ABO blood group compatibility is still a requirement in almost all programs.
Recipients with the AB blood group have no pre-formed antibodies against a donor’s ABO system, irrespective of the donor’s blood group, while recipients with type O blood have antibodies against all donors’ ABO blood groups. Therefore, those with type O blood have to wait the longest for a transplant, while those with type AB blood the shortest. The wait for patients with either type A or B is between the AB and O groups.