Long-term successful liver–kidney transplantation in a child with atypical hemolytic uremic syndrome caused by homozygous factor H deficiency

Background Rational options for the treatment of end-stage renal disease (ESRD) due to atypical hemolytic uremic syndrome (aHUS) in children are still open to discussion. In the case of human complement factor H (CFH) deficiency, the choice is either kidney transplantation in combination with eculizumab, a humanized anti-C5 monoclonal antibody, or a combined liver–kidney transplantation. Case-Diagnosis/treatment A child with a homozygous CFH deficiency underwent a successful liver–kidney transplantation. CFH levels normalized within days. After 6 years of follow-up, the graft function (Cockroft clearance 100 ml min −1 1.73 m −2 ) and the liver functions were normal. Results and Conclusions The results of this long-term follow-up confirm that combined liver–kidney transplantation remains a reasonable option in patients with ESRD due to aHUS when an identified genetic abnormality of the C3 convertase regulator synthesized in the liver has been identified.