Anti‐Factor H Autoantibodies in a Fifth Renal Transplant Recipient with Atypical Hemolytic and Uremic Syndrome

Hemolytic uremic syndrome (HUS) associated with anti‐Factor H (anti‐FH) autoantibodies is a recently described pathophysiological entity. Monitoring of anti‐FH IgG titer may be a sensitive marker of disease activity and guide treatment to eliminate circulating anti‐FH antibodies. We report here a case of atypical HUS (aHUS) in which anti‐FH autoantibodies were detected during the course of a fifth kidney transplant, 30 years after the first flare of aHUS. This exceptional case suggests that early, specific management based on immunosuppressive therapy and plasma exchanges monitored by anti‐FH IgG titer may result in long‐term graft survival. The detection and monitoring of anti Factor‐H auto‐antibodies in an atypical HUS case prevented a relapse in a fifth transplantation.