Recurrent lupus nephritis after transplantation: Clinicopathological evaluation with protocol biopsies

Çeltik, Aygül; Şen, Sait; Tamer, Abdülkerim Furkan; Yılmaz, Mümtaz; Sarsık, Banu; Özkahya, Mehmet; Başçı, Alı; Töz, Hüseyin

doi:10.1111/nep.12657

Cited by 14 publications

(13 citation statements)

References 27 publications

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“…Burgos et al 18 described a protective effect of AZA and adverse effects of tacrolimus and MMF on development of lupus recurrence in 20 LN recipients. Nevertheless, other studies, like the one from Ç eltik et al, 20 reported lupus recurrence in LN recipients treated with AZA. From our data, it is noteworthy that more relevant than the use of AZA itself, all recipients treated with only two immunosuppressive drugs (AZA and PDN) had lupus recurrence.…”

Section: Discussionmentioning

confidence: 94%

Long-term survival of kidney grafts in lupus nephritis: a Mexican cohort

Ramirez‐Sandoval

Chavez-Chavez

Wagner

et al. 2018

Lupus

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Kidney transplant for patients with lupus nephritis (LN) has satisfactory outcomes in studies with short-term or mid-term follow up. Nevertheless, information about long-term outcomes is scarce. We performed a retrospective matched-pair cohort study in 74 LN recipients compared with 148 non-LN controls matched by age, sex, immunosuppressive treatment, human leukocyte antigen (HLA) matches, and transplant period in order to evaluate long-term outcomes of kidney transplant in LN recipients. Matched pairs were predominantly females (83%), median age at transplant surgery of 32 years (interquartile range 23-38 years), and 66% received a graft from a living related donor. Among LN recipients, 5-, 10-, 15-, and 20-year graft survival was 81%, 79%, 57% and 51%, respectively, and it was similar to that observed in controls (89%, 78%, 64%, and 56%, respectively). Graft loss (27% vs. 21%, p = 0.24) and overall survival ( p = 0.15) were not different between LN recipients and controls. Also, there was no difference in episodes of immunological rejection, thrombosis, or infection. Only six LN recipients had biopsy-proven lupus recurrence and three of them had graft loss. In a cohort with a long follow up of kidney transplant recipients, LN recipients had similar long-term graft survival and overall outcomes compared with non-lupus recipients when predictors are matched between groups.

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Section: Discussionmentioning

confidence: 94%

Long-term survival of kidney grafts in lupus nephritis: a Mexican cohort

Ramirez‐Sandoval

Chavez-Chavez

Wagner

et al. 2018

Lupus

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“…Furthermore, physicians may provide protocol-based renal biopsies for post-transplantation surveillance in recipients with class IV LN. 32…”

Section: Discussionmentioning

confidence: 99%

Renal outcome after kidney-transplantation in Korean patients with lupus nephritis

Park

Ahn

Jung

et al. 2017

Lupus

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We investigated renal outcome of kidney-transplantation in 19 Korean recipients with biopsy-proven lupus nephritis and compared it with 18 Korean age- and gender-matched recipients without lupus nephritis who were diagnosed with end-stage renal disease caused by renal diseases other than lupus nephritis in a single centre. We reviewed histological findings of kidneys and calculated cumulative dose of immunosuppressive agents. We assessed renal flare of systemic lupus erythematosus, recurrence of lupus nephritis and graft failure as prognosis. The mean age of recipients with lupus nephritis was 43.5 years and all patients were female. Six patients had class III, 10 had class IV and three had class V. There were no meaningful differences in demographic data, renal replacement modality, cumulative doses of immunosuppressants and prognosis between recipients with and without lupus nephritis. Eight patients experienced renal flare of systemic lupus erythematosus, but there were no cases of recurrence of lupus nephritis or graft failure in recipients with lupus nephritis. Kidney-recipients with class IV lupus nephritis exhibited a lower cumulative renal flare of systemic lupus erythematosus free survival rate than those with class III lupus nephritis. In conclusion, renal outcome of kidney-transplantation in patients with lupus nephritis is similar to that in those without lupus nephritis, and class IV was associated with renal flare of systemic lupus erythematosus.

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“…In contrast to other recurrent diseases such as focal segmental glomerular sclerosis (FSGS) and lupus nephritis, a paucity of data is available to guide our understanding of DN after kidney transplantation. [8][9][10] Current literature regarding post-transplantation DN is composed of small case series and case studies, with limited characterization of this disease. 11,12 Further, many of these studies fail to separate type I from type II diabetes.…”

mentioning

confidence: 99%

Diabetic nephropathy after kidney transplantation in patients with pretransplantation type II diabetes: A retrospective case series study from a high‐volume center in the United States

Cimeno

Munley

Drachenberg

et al. 2018

Clinical Transplantation

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Background Patients with type II diabetes mellitus (DM) undergoing renal transplantation are at risk of diabetic nephropathy (DN) in the transplanted kidney. The true risk of developing post‐transplantation DN is unknown, and post‐transplantation DN is poorly characterized in the literature. Methods The biopsy database at the University of Maryland Medical Center was queried for kidney transplant biopsies which demonstrated evidence of DN. The time from transplantation to biopsy‐proven DN (time to diagnosis, TTD) was calculated and analyzed in the context of demographics, serum creatinine, and onset of diabetes. By extrapolating the total number of patients who developed DN in the last 2 years, we estimated the recurrence rate of DN. Results Sixty patients whose renal biopsies met criteria were identified. The mean age was 56.6 (±1.58) years, and the mean creatinine level at time of biopsy was 1.65 (±0.12) mg/dL. Simultaneous pathological diagnoses were frequent on kidney biopsy; rejection was present at variable rates: classes I, IIA, IIB, and III were 5.0%, 66.7%, 18.4%, and 10%, respectively. The mean TTD was 1456 (±206) days. TTD was significantly shorter for patients receiving a cadaveric vs living donor renal transplant (1118 ± 184 vs 2470 ± 547 days, P = 0.004). Older patients (r = 0.378, P = 0.003) and patients with higher serum creatinine (r = 0.282, P = 0.029) had shorter TTDs. Extrapolations showed that 74.7% of patients would be free of DN 10 years after renal transplantation. Conclusions Diabetic nephropathy occurs after transplantation, and this appears to be due to both donor and recipient‐derived factors. Encouragingly, our estimates suggest that as many as 75% of patients may be free of DN at 10 years following kidney transplantation.

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Recurrent lupus nephritis after transplantation: Clinicopathological evaluation with protocol biopsies

Abstract: Kidney transplantation is a reasonable option for patients with ESRD secondary to SLE. However, recurrence of LN is common if protocol biopsies are included in post-transplantation surveillance.

Cited by 14 publications

References 27 publications

Long-term survival of kidney grafts in lupus nephritis: a Mexican cohort

Long-term survival of kidney grafts in lupus nephritis: a Mexican cohort

Renal outcome after kidney-transplantation in Korean patients with lupus nephritis

Diabetic nephropathy after kidney transplantation in patients with pretransplantation type II diabetes: A retrospective case series study from a high‐volume center in the United States

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