Kidney transplantation for end-stage renal disease in lupus nephritis, a very safe procedure: a single Latin American transplant center experience

Abstract

Background Lupus nephritis (LN) is one of the most frequent complications of SLE and occurs in up to 50% of cases depending on the studied population. Of these, approximately 20% progress to end-stage renal disease (ESRD), with the treatment of choice being a kidney transplant. Objective The objective of this study was to describe the clinical outcome of patients transplanted due to LN, compared with patients transplanted for other causes, in a Latin American population from the Fundación Valle del Lili in Cali, Colombia. Methods Observational, retrospective case study with controls matched by age, sex and type of donor in a single center between 1996 and 2014. Results Sixty-five kidney transplants were performed in patients with LN and ESRD. The survival of patients with LN was 98% at 1, 10 and 15 years ( p = .99). For controls by age and sex, survival was also 98% at 15 years post-transplant, and for controls by donor, the survival rate was 100% at 5 years and 98% at 15 years. Graft survival in patients with LN to 1, 5 and 15 years was 92%, 83% and 71%, respectively; for controls by age and sex, it was 90%, 84% and 64%, respectively, and for the controls by donor, it was 89%, 86% and 79%, respectively ( p = .7718). There were no statistically significant differences found in the cumulative incidence of acute graft rejection in the first year, but it was found that acute rejection is a factor that relates to the loss of function of the renal graft ( p = .032). Of the patients transplanted for LN, two (3.1%) experienced a recurrence of the disease. One patient died after a diagnosis of recurrence of LN due to an infection. Conclusions Kidney transplantation is a good option for patients with ESRD due to LN. In this Hispanic population, the survival of patients, graft survival, and cumulative incidence of graft rejection are not different from those of other transplanted patients. In addition, recurrence of LN was rare, showing the benefits of renal transplantation in LN patients with ESRD.

Transplant outcomes in kidney recipients with lupus nephritis, and systematic review

“…Accordingly, 17 studies were included in the pooled analysis. 7,9–12,15–26

Figure 2Flow diagram of literature search and study selection.

…”

Renal Transplantation and Survival Among Patients With Lupus Nephritis

“…We could not identify a similarly large study of patients with LN-ESRD who were eligible to have a kidney transplant. Although several studies with small sample sizes (patients with LN-ESRD who had a transplant: n = 40 [32], n = 65 [14], and n = 17 [13]) also suggested the potential benefits of renal transplant in this population, their comparison groups were treated with long-term peritoneal dialysis or hemodialysis regardless of eligibility for a transplant. As such, these studies have been highly vulnerable to confounding by contraindication because sicker patients tend to continue long-term dialysis without moving to a transplant waitlist (8).…”

“…However, patients with LN-ESRD may have a heightened risk for certain posttransplant complications (10,11), including infections partly attributed to extensive pretransplant immunosuppression, graft thrombosis related to antiphospholipid antibody syndrome, and recurrent LN affecting the allograft (12). Furthermore, although small-scale studies have reported improved survival for patients who have a transplant compared with those who continue to receive dialysis (13,14), these studies were confounded by indication, because healthier patients had a transplant. As such, the potential survival benefit associated with renal transplant remains unclear among patients with LN-ESRD.…”

Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…146 Clinically significant LN posttransplant recurs in <20% of patients. [147][148][149][150][151] Patients should remain on hydroxychloroquine posttransplant and be on MMF/ CNI-based immunosuppressive regimen. Patients with mild flares can be treated with oral corticosteroids alone.…”