Korean J Transplant.  2023 Nov;37(Suppl 1):S247. 10.4285/ATW2023.F-8402.

An abscess formation on the transplanted graft and its successfully treatment in kidney transplantation recipient with de novo atypical hemolytic uremic syndrome treated with eculizumab: a case report

• Hyun PJ
• Jung CW
• Oh YJ
• Jun H

• KMID: 2551876
• DOI: http://doi.org/10.4285/ATW2023.F-8402

Abstract

Atypical hemolytic uremic syndrome (aHUS) can lead to irreversible graft failure in kidney transplantation (KT), and eculizumab has been considered as a kidney graft rescue therapy. However, due to eculizumabs inhibition of complement effector mechanisms, the risks of infections after its use are major challenges in clinical practice. In here, we present a case of an abscess formation on the transplanted graft and its successfully treatment in a KT recipient with de novo aHUS treated with eculizumab. A 61-year-old female with chronic kidney disease due to diabetes mellitus and hypertension nephropathy had a deceased donor KT. After 4 months, she was readmitted and clinically diagnosed with de novo aHUS. Eculizumab was administered for her treatment concurrently with plasmapheresis. Although her serum creatinine (sCr) normalized after two months of eculizumab treatment, she consistently experienced infections such as recurrent urinary tract infection, pneumonia, herpes zoster, and infected colitis. Over the course of 2 years, she experienced cycles of hospitalization and discharge while receiving ongoing antibiotic treatment for infections. Two years after eculizumab treatment, her general condition deteriorated, leading her to visit the outpatient clinic. Her laboratory results indicated a significant infection with sCr 2.14 mg/dL, white blood cells of 31,230/L and non-enhanced abdominopelvic computer tomography revealed a 6.1-cm abscess formation on the transplanted kidney. Consequently, we promptly inserted percutaneous catheter for drainage on her kidney abscess and initiated antibiotic treatment. Aerobic cultures from her abscess and her urine showed ESBL-producing Escherichia coli. After 2 weeks of treatment, her sCr was dramatically decreased to around 1.0 mg/dL in the early stages. Based on our experience, it is important to closely monitor the risk of infections in immunocompromised patients treated with eculizumab. Furthermore, proactive, prompt and appropriate treatments for infections are essential.