The outcome of renal transplantation among systemic lupus erythematosus patients

Abstract

Background. Clinical outcome of renal transplantation among systemic lupus erythematosus (SLE) patients remains a topic of controversy. Most of the previous reports were based upon small single-centre studies that were not always well-designed. Methods. We conducted the retrospective analysis using data from USRDS and UNOS databases. Patients were divided into five groups based on the cause of end-stage renal disease (ESRD): diabetes mellitus (DM), SLE, glomerulonephritis, hypertension and other causes. Between 1990 and 1999, 2886 renal transplantation recipients with ESRD due to SLE were identified from a total of 92 844 patients. Results. The mean follow-up period of this study was 4.7 AE 2.4 years. While unadjusted analysis using Kaplan-Meier curves demonstrated an association between SLE and improved allograft survival compared with DM, in multivariate analysis the SLE group had worse allograft [hazard ratio (HR) 1.09, P < 0.05] and recipient (HR 1.19, P < 0.05) survival compared with the DM group. Subgroup analysis based on the type of donor showed that SLE patients who received deceased donor allograft had worse allograft and recipient survival (HR 1.14, P ¼ 0.002 and HR 1.30, P ¼ 0.001, respectively) compared with non-SLE deceased donor allograft recipients. Among living allograft recipients, there were no significant differences in either allograft or recipient survival compared with non-SLE recipients. Conclusions. SLE as a cause of ESRD in renal transplant recipients is associated with worse allograft and recipient survival compared with DM; this association is true for the entire population and for the recipients of deceased donor (but not living donor) transplant. Deceased donor allograft recipients have worse outcomes compared with living allograft recipients.

Renal transplantation in lupus nephritis: a Brazilian cohort

“…6,7,18 In the survival analysis, we found encouraging graft survival rates. Our sample did not include a control group, as many published studies; 6,7,10,13,18 however, performing retrospective studies that include real-life cases, even with well-matched Renal transplantation in lupus nephritis: a Brazilian cohort CS Oliveira et al…”

Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis

“…Comparative studies131 132 and cases series133 134 support that patients with SLE are good candidates for renal transplantation performed when clinical (and ideally, serological) lupus activity is absent, or at a low level, for at least 3–6 months135; best results are obtained with living donor136–138 and pre-emptive transplantation 139. Patients with moderate to high titres of anti-phospholipid antibodies are at increased risk for thrombotic complications and may receive anticoagulants perioperatively 140–143.…”

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

“…In retrospective studies performed on databases, the deceased donor allograft recipients have worse outcomes compared with living allograft recipients [30] and African American and Caucasian Americans have similar allograft failure rates [36]. …”