PROGNOSTIC FACTORS AND EARLY RESUMPTION OF CYCLOSPORINE-A IN RENAL-ALLOGRAFT RECIPIENTS WITH THROMBOTIC MICROANGIOPATHY AND HEMOLYTIC-UREMIC SYNDROME

Biopsy-proven thrombotic microangiopathy (TMA) was found in 22 of 436 (5%) renal transplant recipients, with similar incidence in recipients of cadaver or living related allografts. All patients with TMA presen ted different degrees of severity of the hemolytic uremic syndrome (HU S). Prognosis was poor when HUS occurred shortly after transplant in r ecipients of cadaveric kidneys (55% graft loss). It was more favorable when HUS occurred later in the post-transplant course or in recipient s with allografts from living related donors, irrespective of time of occurrence. Other factors such as extent of TMA, degree of thrombocyto penia, hemolysis or renal dysfunction were not predictive of graft los s. Cyclosporine was resumed in 14 of 16 recipients shortly after clini cal recovery without recurrence of HUS. In conclusion, HUS carries poo r prognosis when occurring shortly after transplant in cadaver kidney recipients. Once the graft function improves, cyclosporine can be safe ly resumed.