Outcome of renal transplantation in patients with systemic lupus erythematosus

Abstract

Renal transplantation is considered to be a good treatment option for patients with systemic lupus erythematosus (SLE) and end-stage renal disease. However, in patients with glomerular diseases, the outcome of renal transplantation can be adversely affected by recurrence of the original disease. Furthermore, the post-transplant course might be complicated by pretransplant morbidity and treatment history. We studied the outcome of renal transplantation in patients with SLE who underwent transplantations in our center between 1968 and 2001. Patient and graft survival were compared with a matched control group. We specifically looked for any evidence of recurrent disease. There were 23 patients (two male, 21 female) with a mean + SD age of 34 f 12 years at transplantation. One patient developed renal failure with serological evidence of SLE activity at 61 months after transplantation. In the absence of urine abnormalities we favored the diagnosis of rejection, although recurrence of lupus nephritis could not formally be excluded. This was the only case of a possible recurrence of lupus nephritis. Two other patients developed extra-renal manifestations of SLE at 6 and 17 months after transplantation. Patient and graft survival rates at 5 years after transplantation were 86% and 68%, respectively. Survival rates were not significantly different from those of a matched control group, 95% and 78%, respectively. Recurrence of SLE after transplantation is rare. The results of renal transplantation in patients with SLE do not differ significantly from a matched control group. Renal transplantation is a good alternative for renal replacement therapy in patients with lupus nephritis.

Renal transplantation in lupus nephritis: a Brazilian cohort

“…6 Our sample consisted mostly of nonCaucasian patients, comparable with most of the studies with an American population, that is characterized by a mixture of races including Caucasians, Afro-descendents and Latin Americans. 6,10,[12][13][14] Another factor was the agreement of the mean age at transplantation (33 AE 9 years), comparable with most studies, 4,5,8,12,13,[15][16][17] which confirms that patients with SLE who underwent RRT are younger and less subject to comorbidities than the general population on dialysis. 6,7,18 In the survival analysis, we found encouraging graft survival rates.…”

“…25 The data in the literature about recurrence of lupus nephritis also are conflicting, ranging from 1.6-8.6%. 5,6,8,13,14,17,18,20 Younger recipients 13 and the presence of lupus anticoagulant 17 were found to be the risk factors for lupus nephritis recurrence. In the Brazilian population, there is only one study evaluating the frequency of recurrent lupus nephritis.…”

“…controls, 5,8,19,20 may still present an undesirable selection bias that interferes with the results due to having to depend upon almost always incomplete records. Since the Renal Transplant Registry study carried out in 1975, 3 RTx in patients with SLE has no longer been considered untenable.…”

Recurrence of Secondary Glomerular Disease after Renal Transplantation

“…A review of the United Network for Organ Sharing (UNOS) data reported that graft failure in patients with recurrent LN was attributable to recurrence in only 7% of patients, rejection being the main cause of graft failure (11). Single-center studies also pointed out that the main causes of graft failure in transplant patients with LN was either rejection (4,13,20,21) or chronic allograft nephropathy (16), rather than recurrence of LN.…”

“…The studies that compared the results of renal transplantation in LN patients with those of wellmatched controls usually reported that patient and graft survival were similar in the two groups even in the longterm (3,6,7,12,13,21). Also, morbidity after transplantation was similar in patients with LN and in well-matched controls, with the exception of thrombotic events that were more frequent in LN (26).…”