Systemic Lupus Erythematosus after Renal Transplantation: Patient and Graft Survival and Disease Activity

Nossent, Jiri; Swaak, Tom J. G.; Berden, Jo H. M.

doi:10.7326/0003-4819-114-3-183

Cited by 85 publications

(33 citation statements)

References 19 publications

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“…The previously reported incidence of RLN after transplantation has ranged from 0 to 44%. [3][4][5][6][7][8][9][10][11][12]26,27 This wide range is probably due in part to the differences among centers in the use of complete examination of biopsies in recipients with SLE, the performance of serial biopsies, the period of observation, the population characteristics, and the immunosuppressive regimen used. Particularly, the use of light microscopy alone in the examination of biopsy specimens would likely yield a low rate of RLN diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of Lupus Nephritis after Kidney Transplantation

Contreras¹,

Mattiazzi²,

Guerra³

et al. 2010

Journal of the American Society of Nephrology

128

119

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The frequency and outcome of recurrent lupus nephritis (RLN) among recipients of a kidney allograft vary among single-center reports. From the United Network for Organ Sharing files, we estimated the period prevalence and predictors of RLN in recipients who received a transplant between 1987 and 2006 and assessed the effects of RLN on allograft failure and recipients' survival. Among 6850 recipients of a kidney allograft with systemic lupus erythematosus, 167 recipients had RLN, 1770 experienced rejection, and 4913 control subjects did not experience rejection. The period prevalence of RLN was 2.44%. Non-Hispanic black race, female gender, and age Ͻ33 years each independently increased the odds of RLN. Graft failure occurred in 156 (93%) of those with RLN, 1517 (86%) of those with rejection, and 923 (19%) of control subjects without rejection. Although recipients with RLN had a fourfold greater risk for graft failure compared with control subjects without rejection, only 7% of graft failure episodes were attributable to RLN compared and 43% to rejection. During follow-up, 867 (13%) recipients died: 27 (16%) in the RLN group, 313 (18%) in the rejection group, and 527 (11%) in the control group. In summary, severe RLN is uncommon in recipients of a kidney allograft, but black recipients, female recipient, and younger recipients are at increased risk. Although RLN significantly increases the risk for graft failure, it contributes far less than rejection to its overall incidence; therefore, these findings should not keep patients with lupus from seeking a kidney transplant.

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Section: Discussionmentioning

confidence: 99%

Recurrence of Lupus Nephritis after Kidney Transplantation

Contreras¹,

Mattiazzi²,

Guerra³

et al. 2010

Journal of the American Society of Nephrology

128

119

View full text Add to dashboard Cite

show abstract

“…It was presumed that the underlying pathophysiology would result in recurrence of lupus nephritis, even though the immunosuppressive drugs given to prevent graft rejection suppress SLE disease activity (8). While recurrence of lupus nephritis in allografts has been reported in a small number of cases, concerns about recurrence and graft destruction have been largely allayed (9)(10)(11). A 1975 report citing 56 cases from 36 centers established that recipients with SLE had 1-and 2-year graft survival comparable to recipients with other causes of renal failure (12).…”

Section: Systemic Lupus Erythematosus and Renal Transplantationmentioning

confidence: 99%

Pregnancy Outcomes in Female Renal Recipients: A Comparison of Systemic Lupus Erythematosus With Other Diagnoses

McGrory¹,

McCloskey²,

DeHoratius

et al. 2003

American Journal of Transplantation

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This study compares pregnancy outcomes in systemic lupus erythematosus (SLE) patients post renal transplant with recipients with other primary diagnoses, utilizing data from the National Transplantation Pregnancy Registry, Philadelphia, PA. Recipients were referred from transplant centers nationwide. A retrospective analysis was performed using data from questionnaires, hospital records and telephone interviews. Outcomes of pregnancies post renal transplant secondary to lupus nephritis (SLE: n Ω 38; 60 pregnancies) were compared with the pregnancy outcomes of renal recipients with other diagnoses (non-SLE: n Ω 247; 374 pregnancies). Drug-treated hypertension during pregnancy was less common in the SLE group than in the non-SLE group (45.0% vs. 62.5%, p Ω 0.015). There were fewer cesarean sections in the SLE group (30.2 vs. 53.2%, p Ω 0.008). There was no primary or gestational diabetes in the SLE group. There were no other statistical differences in maternal conditions or pregnancy outcomes between the SLE and non-SLE groups, or in the incidence of post pregnancy graft loss. Female recipients transplanted for renal failure secondary to lupus nephritis can successfully maintain pregnancy. Outcomes are comparable to renal recipients with other diagnoses. Newborns in both groups were often premature and had low birthweight. Overall childhood health was reported to be good; there were no apparent predominant structural malformations among the children.

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“…Systemic lupus erythematosus (SLE) is the cause of renal failure in approximately 5% of patients with ESRD (Table 42) (310,(366)(367)(368)(369)(370)(371)(372)(373)(374)(375)(376)(377). While there are reports of successful transplantation with active SLE (366)(367)(368)372), it is generally recommended that clinical manifestations (renal and extra-renal) be quiescent on minimal doses of corticosteroids, e.g.…”

Section: The Evaluation Of Renal Transplant Candidates: Clinical Pracmentioning

confidence: 99%

“…While there are reports of successful transplantation with active SLE (366)(367)(368)372), it is generally recommended that clinical manifestations (renal and extra-renal) be quiescent on minimal doses of corticosteroids, e.g. no more than 10 mg per day of prednisone, before transplantation.…”

Section: The Evaluation Of Renal Transplant Candidates: Clinical Pracmentioning

confidence: 99%

“…Furthermore, it is suggested that serologic parameters (complement, anti-nuclear antibody, anti-DNA antibody titers) should be normal, or at least stable before transplantation (371), although clinical evidence supporting this recommendation is lacking. Patients can be told that less than 10% of transplant recipients with SLE have recurrence (310,(366)(367)(368)(369)(370)(371)(372)(373)(374)(375)(376)(377). Clinical presentation may be extra-renal (rash, arthralgias, Raynaud's phenomenon) or renal (proteinuria, graft dysfunction).…”

Section: The Evaluation Of Renal Transplant Candidates: Clinical Pracmentioning

confidence: 99%

See 1 more Smart Citation

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

2001

American Journal of Transplantation

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Systemic Lupus Erythematosus after Renal Transplantation: Patient and Graft Survival and Disease Activity

Abstract: Patients with systemic lupus erythematosus and end-stage renal failure are excellent candidates for renal transplantation; disease activity after transplantation is sporadic and low, and the recurrence of lupus nephritis is rare.

Cited by 85 publications

References 19 publications

Recurrence of Lupus Nephritis after Kidney Transplantation

Recurrence of Lupus Nephritis after Kidney Transplantation

Pregnancy Outcomes in Female Renal Recipients: A Comparison of Systemic Lupus Erythematosus With Other Diagnoses

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

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