Outcome and Prognosis of Patients With Lupus Nephritis Submitted to Renal Transplantation

Abstract

This stydy aimed to evaluate the epidemiological and clinical profile and outcome of patients with lupus nephritis (LN) submitted to renal transplantation. Retrospective cohort study based on the records of 35 LN patients submitted to renal transplantation at a single center in Brazil between July 1996 and May 2016. The Kaplan-Meier method was used to estimate 6-month, 1-year and 5-year graft survival. The sample included 38 transplantations (3 of which retransplantations). The mean age at the time of SLE diagnosis was 23.7 ± 9.0 years. Most patients were female (94.7%) and 68.4% were non-Caucasian. Twenty-two (57.9%) underwent renal biopsy prior to transplantation. The mean time from SLE diagnosis to transplantation was 10.3 ± 6.4 years. The mean pre-transplantation dialysis time was 3.8 ± 3.7 years. The grafts came from living related (n = 11) or deceased (n = 27) donors. Three (7.9%) patients experienced acute rejection in the first year. Graft and patient survival rates were, respectively, 97.1% and 100% at 6 months, 84.9% and 96.9% at 1 year, and 76.3% and 92.5% at 5 years. One (2.6%) patient had SLE recurrence. Venous thrombosis ( p = 0.017) and antiphospholipid syndrome (APS) ( p = 0.036) were more prevalent in patients with graft loss. In our cohort of LN patients submitted to renal transplantation, the 5-year survival rate was high, and APS was an important predictor of poor renal outcome (graft loss).

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America

“…38 In this study, death-censored graft survival rates for the first renal transplant were similar to those described by other authors (Table 4). 7,[9][10][11][15][16][17][18][19][22][23][24][27][28][29][30]32 Studies conducted in Latin America, where SLE patients are mostly Mestizos, showed graft survival rates similar to those found in our cohort. Naranjo-Escobar et al, 11 showed similar graft survivals in Colombian patients (92% at one year, and 83% at five years), while in a Mexican study by Ram ırez-Sandoval, et al, 16 a graft survival of 81% was found at five years and 79% at ten years.…”

“…In our population, patient survival rates were lower than those reported in other studies (Table 4). 7,[9][10][11][15][16][17][18][19][22][23][24][27][28][29][30]32 These differences could partially be explained by different times of kidney transplant or recruitment period. In this light, the patient survival rates in our cohort at one, three, and five years after 2005 (93%, 93%, and 85%, respectively) were significantly better than those observed before 2005 (85%, 75%, 74%, respectively).…”

“…This finding is consistent with the incidence of clinically significant RLN reported in the literature, ranging from 1.1% to 13%. 2,11,[16][17][18]20,22,23,[27][28][29][30]32 However, the incidence of RLN in our cohort could be even higher for several reasons. First, as the renal biopsies were performed for clinical indications (proteinuria, hematuria, increased serum creatinine), subclinical recurrence may have been underestimated.…”

“…7,9,22,23,28,29 Limited data are available from Latin American LN patients who underwent kidney transplantation. 11,13,16,[29][30][31][32] Thus, the objective of this study was to assess patient and graft outcomes in a predominantly Mestizo Latin American population with SLE undergoing kidney transplantation in a Colombian single-center.…”

Lupus Nephritis; Pathogenesis and Treatment Update Review

“…Before transplantation, it is essential to ensure that SLE is in remission status, and three months period of dialysis is usually advisable. It is well documented that the transplanted kidney in LN patients survives less than the kidney transplanted in patients without LN, and the patient outcome is better with living-related than the cadaveric allografts, although it can be conducted from cadaveric and non-related live donor with reasonable improvement of outcome (86). The reasons for the early graft failure in LN are not clear enough, however, they are probably due to LN reoccurrence and/or concomitant antiphospholipid antibody syndrome (87).…”