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Recurrence of hemolytic-uremic syndrome (HUS) in the allograft is associated with a very poor renal prognosis. Meta-analysis of previous trials may allow us to better estimate its real frequency, to identify risk factors for recurrence, and to predict the outcome of patients with definite recurrence.An exhaustive search was conducted of HUS recurrence in renal transplantation from January 1977 to June 1997 using MEDLINE.Ten studies comprising 159 grafts in 127 patients were identified. The rate of recurrence was 27.8%. One-year graft survival was 76.6% in patients without recurrence and 33.3% in patients with recurrence(P<0.001). Older age at onset of HUS (16.96±7.6 years vs. 9.95±6.55 years; P<0.02), shorter mean interval between HUS and transplantation (2.51±2.7 years vs. 6.03±6.4 years; P<0.01), shorter mean interval between HUS and end-stage renal disease (0.79±0.39 years vs. 2.78±2.47 years; P<0.01), living-related donors, and the use of calcineurin inhibitors were associated with recurrence.Risk factors for HUS recurrence in renal transplantation could be identified through this meta-analysis.