Haemolytic uraemic syndrome after living-donor liver transplantation: Is small-for-size graft a potential risk factor?

Haemolytic uraemic syndrome (HUS) is a rare complication of solid organ transplantation. Immunosuppressive drugs, including cyclosporin A and tacrolimus, have frequently been incriminated. Here we report a case of tacrolimus-induced HUS in a woman with small-for-size syndrome after living-donor liver transplantation. Hypertension, microangiopathic anaemia and end-stage renal failure occurred in the immediate post-transplant period; all other risk factors that might be implicated in the development of HUS were investigated and excluded if no evidence was found. A possible association between small-for-size syndrome, which frequently results in a high blood concentration of tacrolimus post-operatively, and the occurrence of HUS is discussed.