Original investigations
Transplantation
The Long-Term Prognosis of Renal Transplantation in Patients With Lupus Nephritis

https://doi.org/10.1053/j.ajkd.2005.01.038Get rights and content

Background: Few data are available about the long-term outcome of renal transplantation in patients with systemic lupus erythematosus (SLE). Methods: Between June 1982 and 2004, a total of 33 adults with lupus nephritis received 35 kidney allografts. Outcomes of these grafts and those of 70 controls matched for age, sex, and donor source who underwent transplantation during the same period were compared. Results: Mean follow-up after renal transplantation was 91 ± 59 months for patients with lupus and 90 ± 64 months for controls. Actuarial 15-year patient (80% versus 83%) and death-censored graft survival rates (69% versus 67%) were not significantly different between patients with lupus and controls. Risks for acute and chronic rejection, arterial hypertension, and infection were not different between the 2 groups. Mean serum creatinine levels also were similar in the 2 groups at the last follow-up visit. Intravascular thrombotic events occurred in 9 patients with SLE (26%) and 6 controls (8.6%; P = 0.038). In the SLE group, 6 of 7 antiphospholipid (aPL) antibody-positive versus 3 of 17 aPL antibody-negative patients experienced thrombotic events (P = 0.015). Recurrence of lupus nephritis was documented in 3 renal grafts (8.6%), but no graft was lost because of recurrent lupus nephritis. Conclusion: Long-term patient and graft survival probabilities were similar in patients with SLE and matched controls. The risk for thrombotic complications was greater in patients with SLE, particularly aPL-positive patients. Nephritis recurred in less than 10% of patients with SLE and did not influence graft survival.

Section snippets

Patients

Adult (>18 years) patients with SLE who received a kidney transplant at Ospedale Maggiore, Milan, Italy, between June 1982, when the first renal transplantation in a patient with lupus nephritis was performed, and January 2004 were admitted to the study. The diagnosis of SLE had to match American College of Rheumatology criteria.16 The diagnosis of lupus nephritis was based on clinical and serological criteria,16 as well as renal biopsy, according to the World Health Organization classification.

Results

We performed the first renal transplantation in a patient with SLE in June 1982. Since then, of 1,302 renal transplantations performed up to January 2004, a total of 35 renal transplantations (2.8%) in 33 patients with a diagnosis of lupus nephritis were performed (2 patients received 2 renal transplants). Eleven of these transplantations were performed between 1982 and 1990, 21 were performed between 1991 and 2000, and 3 were performed after 2000. Twenty-six of these patients (79%) had

Discussion

There is general agreement that patient survival is similar in adult renal transplant recipients with or without SLE, although only a few studies reported results at 10 years.5, 7, 11, 12 Instead, controversy still exists about kidney allograft survival in patients with SLE. Only 7 studies compared graft outcomes of transplant recipients with SLE with those of well-matched controls. In 2 of these studies, renal graft survival was lower in patients with than without lupus.5, 6 In another 5

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    Originally published online as doi:10.1053/j.ajkd.2005.01.038 on March 16, 2005.

    Supported in part by the grant Project in Glomerulonephritis in memory of Pippo Neglia. C.P. is an external consultant of Novartis Italy.

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