Impact of recurrent lupus nephritis on lupus kidney transplantation

Abstract

This study was conducted to delineate the frequency of recurrent lupus nephritis in a Chinese kidney transplant cohort and to estimate its impact on long-term transplant outcomes. A total of 32 lupus transplant patients were enrolled in this study, and the medical records were retrospectively reviewed. Patients with unexplained graft abnormalities were subjected to allograft biopsy. Recurrent lupus nephritis was diagnosed by light microscopy, immunofluorescence, and electron microscopy. In addition, to determine the clinical manifestations of recurrent lupus GN in these patients, serum original systemic lupus erythematosus disease activity index (SLEDAI) scores while undergoing allograft biopsy were evaluated. In total, six out of 32 patients (18.8%; mean age, 40.5 ± 9.1 years) were diagnosed as having recurrent lupus nephritis and the mean time at diagnosis was 5.1 ± 4.9 years post-transplantation. According to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 criteria, three of the six cases (50%) were defined as class I, one was class II, one was class IV, and one was class III + V. The graft and patient survival rates of recurrent lupus nephritis (n = 6) were not different from those of patients with other diagnostic entities. Although recurrent lupus nephritis was not uncommon, it did not appear to have a strong negative impact on long-term outcome in Chinese kidney transplant patients. The recurrence was potentially treatable and should not be precluded for receiving transplantation.

Renal Transplantation in Systemic Lupus Erythematosus: Outcome and Prognostic Factors in 50 Cases from a Single Centre

“…These observations are similar to those reported in other recent studies from other single centers including patients from different ethnicities [22–27]. The main cause of graft failure was chronic allograft nephropathy, which is similar to data previously reported for SLE patients and also for non-SLE transplant recipients [28].…”

“…Of note, 83% of the transplanted kidneys presented with signs of chronic allograft nephropathy, regardless of the presence or absence of lupus nephritis. Similar results of recurrence of lupus nephritis have been described in a Chinese kidney transplant cohort of 32 SLE patients [22]. …”

Recurrent lupus nephritis after transplantation: Clinicopathological evaluation with protocol biopsies

“…There was no clinical or histological evidence of recurrence in a Brazilian study that included only indication biopsies examined by LM . A few studies diagnosed LN by histological evaluation with IF and EM and reported higher recurrence rates . In a recent study, recurrent disease was detected in 18.8% of 32 recipients who were evaluated by indication biopsies only .…”

“…In the previous studies, the recurrence rate of LN was between 0–54% after KTx . Differences in the population characteristics, immunosuppressive regimens, biopsy indications and histological assessment of graft biopsies may contribute to this wide range.…”

“…A few studies diagnosed LN by histological evaluation with IF and EM and reported higher recurrence rates . In a recent study, recurrent disease was detected in 18.8% of 32 recipients who were evaluated by indication biopsies only . In the study of Goral et al ., the recurrence rate was 30% .…”