Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis in Kidney Transplantation

Abstract

Due to complex comorbidity, high infectious complication rates, an elevated risk of relapsing for primary renal disease, as well as inferior recipient and allograft survivals, individuals with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAVs) are often considered as poor transplant candidates. Although several aspects of recurrent and de novo AAVs remain unclear, recent evidence suggests that kidney transplantation (KT) represents the best option, which is also the case for this particular subgroup of patients. Special counselling and individualized approaches are strongly recommended at the time of enlistment and during the entire post-transplant follow-up. Current strategies include avoiding transplantation within one year of complete clinical remission and thoroughly assessing the recipient for early signs of renal or systemic vasculitis. The main clinical manifestations of allograft AAV are impaired kidney function, proteinuria, and hematuria with ANCA positivity in most cases. Mixed results have been obtained using high-dose steroids, mycophenolate mofetil, or cyclophosphamide. The aim of the present review was to summarize the available literature on AAVs in KT, particularly focusing on de novo pauci-immune glomerulonephritis.

Clinical and Surgical Challenges in Kidney Transplantation: Toward a Personalized Approach?

“…Consolidated knowledge and evidence-based care constantly mutate to adapt new scientific advances to old and emerging clinical or surgical challenges. Necessarily, the progressive changes in our praxis contribute to addressing the issues we face every day, from the well-established [ 1 , 2 , 3 ] to the uncommon ones [ 4 ], as well as to the unprecedented crisis caused by the ongoing SARS-CoV-2 pandemic [ 5 ].…”

“…In their contribution, Moroni and colleagues described how the fate of patients with ANCA-associated vasculitis and chronic kidney disease has changed dramatically over the last decade. Once recognized as poor transplant candidates, this complex group of recipients is now routinely transplanted with encouraging long-term recipient and allograft survivals [ 4 ]. In a provocative manuscript, Nardelli and coworkers questioned the preferential use of hemodialysis over peritoneal dialysis in patients awaiting a KT, promoting a more flexible (and perhaps less biased) vision of the two renal replacement modalities [ 3 ].…”