Approach to the prevention of atypical hemolytic uremic syndrome recurrence using eculizumab in a pregnant kidney transplant recipient with complement factor H gene mutation: a case report and literature review.

Eculizumab, a monoclonal antibody targeting C5, is used to treat atypical hemolytic uremic syndrome (aHUS) and prevent recurrence post-kidney transplant (KTx). However, clinical experience with its use during pregnancy in kidney transplant recipients remains limited. We report a case of a 36-year-old woman with a history of aHUS and a high-risk complement factor H gene mutation who received a KTx and was treated with maintenance eculizumab post-transplant for the prevention of aHUS recurrence, and who later became pregnant. Eculizumab maintenance was continued during pregnancy. The patient delivered a healthy infant who developed normally; allograft function was well-preserved with no recurrence of thrombotic microangiopathy during pregnancy or in the 8 years postpartum. We reviewed the literature for similar cases and herein propose a structured approach to managing pregnant KTx recipients with a history of aHUS receiving eculizumab.