More than 50% of patients with non-
Shiga toxin-associated
hemolytic uremic syndrome (
non-Stx-HUS) progress to
ESRD. Kidney transplant failure for disease recurrence is common; hence, whether
renal transplantation is appropriate in this clinical setting remains a debated issue. The aim of this study was to identify possible prognostic factors for renal transplant outcome by focusing on specific genetic abnormalities associated with the disease. All articles in literature that describe renal transplant outcome in patients with
ESRD secondary to
non-Stx-HUS, genotyped for CFH, MCP, and IF mutations, were reviewed, and data of patients who were referred to the International Registry of Recurrent and Familial HUS/
TTP and data from the Newcastle cohort were examined. This study confirmed that the overall outcome of
kidney transplantation in patients with
non-Stx-HUS is poor, with disease recurring in 60% of patients, 91.6% of whom developed graft failure. No clinical prognostic factor that could identify patients who were at high risk for graft failure was found. The presence of
a factor H (CFH) mutation was associated with a high incidence of graft failure (77.8 versus 54.9% in patients without CFH mutation). Similar results were seen in patients with
a factor I (IF) mutation. In contrast, graft outcome was favorable in all patients who carried a membrane co-factor
protein (MCP) mutation. Patients with
non-Stx-HUS should undergo genotyping before
renal transplantation to help predict the risk for graft failure. It is debatable whether a kidney transplant should be recommended for patients with CFH or IF mutation. Reasonably, patients with an MCP mutation can undergo a kidney transplant without risk for recurrence.