Zuber J, Frimat M, Caillard S, et al. - In this retrospective multicenter study, researchers investigated how kidney transplant prognosis can be influenced by using highly individualized complement blockade–based prophylaxis with eculizumab to prevent post-transplant atypical hemolytic uremic syndrome (HUS) recurrence–a strategy suggested by experts in late 2011 in France. To address this question, they used an extensive French nationwide registry, registering all adult patients with atypical HUS in whom complement analysis and a kidney transplant have already been performed. In a population-based cohort study, they evaluated the evolution of epidemiology of atypical HUS in France in the eculizumab era, by analyzing 397 adult patients with atypical HUS. They found an independent association of prophylactic eculizumab use with a significantly decreased risk of recurrence and with significantly longer graft survival. In this observational analysis, the provision of eculizumab prophylaxis based on pretransplant risk stratification was shown to confer benefit.