Kidney Transplantation in Systemic Lupus erythematosus Nephritis: A One-Center Experience

Abstract

Eight patients with end-stage renal disease secondary to systemic lupus erythematosus (SLE) received 8 cadaveric renal allograft. Patient and graft survival was 100 and 87%, respectively. None of them showed extrarenal manifestations of SLE or recurrence of lupus nephritis after grafting. One graft was lost because of chronic rejection. In another patient, an episode of graft function deterioration due to bad control of arterial hypertension was observed. Three patients were transplanted during their first year on hemodialysis. Two women became pregnant after successful kidney transplantation; one suffered a spontaneous abortion and the other had a successful delivery. In neither of them, was SLE observed during or after pregnancy. Morbidity was low in this series, and infections were the most frequent complication. In summary, our experience with renal transplantation in SLE patients compares, favorably with the general nodiabetic transplanted population.

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

“…As reported by others, pregnancy does not appear to have a negative impact on graft survival. (3,28,38,68). Graft loss at any time postconception was also similar between the two groups, and comparable to losses reported for other post-pregnancy renal recipients, nonpregnant recipients, and male recipients (66,68).…”

“…Patients with end stage renal disease (ESRD) secondary to lupus nephritis account for 1-2% of hemodialysis patients and those awaiting transplants (3,4). Both uremia and dialysis are associated with subsequent quiescence or 'burn-out' of SLE disease activity (5-7).…”

Factors affecting kidney‐transplant outcome in recipients with lupus nephritis

“…These concerns were later allayed after the American Colleges of Surgeons/National Institute of Health (ASC/NIH) transplant registry reported that the allograft and recipient survival rates of lupus nephritis patients were comparable to non‐lupus kidney‐transplant recipients (2). Subsequently, after additional reports demonstrated similar results (3–12), renal transplantation became the established mode of treatment for ESRD owing to lupus nephritis. However, most of those reports were single‐center studies and did not account for the unique transplant patient characteristics of SLE patients.…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…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.…”

“…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).…”