Kidney transplantation in systemic lupus erythematosus: Outcomes and prognosis

Pampa-Saico, Saúl; Marcén-Letosa, Roberto; Fernández-Rodríguez, Ana; Díaz-González, Laura E.; Jiménez-Álvaro, Sara; García, Fernando L. de la Vega

doi:10.1016/j.medcle.2019.10.002

Cited by 3 publications

(6 citation statements)

References 10 publications

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“…26 In our study, regarding the causes of graft loss, there were no differences between the compared groups, the main cause being chronic graft nephropathy, as in most previous studies. 8,14,20 Regarding the survival of transplant patients, our data are similar to those described by other authors who compare patients with LN and other etiologies. [12][13][14][15] Although mortality did not differ between the two groups, infections were the main cause of death, 14,15 which denotes the profound immunosuppression suffered by these patients and the need to deepen preventive strategies.…”

Section: Discussionsupporting

confidence: 89%

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Results and prognosis of kidney transplantation in lupus nephritis: Experience of an Argentine center

Ornella,

García,

Cosentino

et al. 2024

Lupus

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Introduction Although RT has improved the survival of the population with ESRD due to all causes, renal outcomes in SLE are controversial. The objective of this study is to describe the characteristics and evolution of the patients and the kidney transplant in LN, and compare it with patients transplanted for other causes. Materials and methods Retrospective, observational, analytical, single-center study in which records of patients undergoing nephrotransplantation for LN were analyzed. They were compared with a group of patients transplanted at the same center for other causes of ESRD. Results 41 patients with kidney transplant due to SLE and 89 transplanted due to other causes of ESRD were registered. Graft loss occurred in 12 (29.26%) patients with LN and 34 (38.2%) patients in the comparison group ( p = .428). Only one case (4.8%) presented reactivation of the LN in the graft, without graft loss. Median graft survival was 73.1 months in the LN group and 66.3 months in the comparison group ( p = .221). A total of 8 (19.5%) patients with LN and 11 (12.4%) without LN died ( p = .42), with infections being the main cause in both groups. There were no statistically significant differences between groups in graft and patient survival. In a sub-analysis of 28 patients with LN with aPL study, 4 thrombotic events were observed, in 3 different patients, in the aPL-positive group. There were no statistically significant differences in terms of causes of graft loss and graft survival (positive aFL 75.7 months vs negative aFL 72.7 months, p= .96). There were also no differences in mortality between the groups ( p = .61). Conclusion Patients transplanted for LN did not differ from the control population in terms of graft and patient survival. Infections were the main cause of death, so prophylaxis and vaccination continue to be a fundamental pillar in the prevention of infections in immunocompromised patients.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Results and prognosis of kidney transplantation in lupus nephritis: Experience of an Argentine center

Ornella,

García,

Cosentino

et al. 2024

Lupus

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“…Full texts of the remaining 46 studies were screened. Finally, 15 studies [ 5 , 6 , 8 , 9 , 15 , 16 , 19 , 21 , 23–25 , 28 , 30 , 38 , 40 ] were included in the meta-analysis. The studies that were excluded at the time of full-text review have been presented in Supplementary table 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Despite advances in immunosuppressive therapies and transplant techniques, the outcomes of kidney transplantation in patients with LN remain unclear. While some reports indicate comparable graft survival rates and patient survival outcomes in this population when compared to patients with ESRD of other etiology, others show evidence of the increased risks of acute rejection, graft loss, and mortality in recipients with a history of lupus nephritis [ 6 , 9 , 28 , 30 , 38 , 40 ]. A review and meta-analysis of Kim et al.…”

Section: Introductionmentioning

confidence: 99%

Graft survival and mortality outcomes after kidney transplant in patients with lupus nephritis: a systematic review and meta-analysis

Jiang,

Xu,

Yin

2024

Renal Failure

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To explore the effect of lupus nephritis (LN) on graft survival in renal transplant patients. Literature search was conducted in PubMed, EMBASE and Scopus database for randomized controlled trials (RCTs), cohort, and case-control studies. The target population of interest was adult patients (aged >18 years) with end-stage renal disease (ESRD) and no history of previous renal transplants. Primary outcomes of interest were graft survival and patient survival. Pooled effect estimates were calculated using random-effects models and reported as hazard ratio (HR) with 95% confidence intervals (CI). A total of 15 studies were included. Compared to patients with ESRD due to other causes, patients with LN undergoing kidney transplant had lower patient survival rate (HR 1.15, 95% CI: 1.01, 1.31; N = 15, I 2 =34.3%) and worse graft survival (HR 1.06, 95% CI: 1.01, 1.11; N = 16, I 2 =0.0%), especially when studies with deceased donor were pooled together. Studies with a larger sample size (>200) showed that LN was strongly associated with lower graft and patient survival rates. Elevated risk of mortality in LN patients was detected in case-control studies, but not RCTs. On the other hand, RCTs, but not case-control studies, showed an increased risk of poor graft survival in LN patients. The findings suggest that the presence of LN might have a negative impact on both the graft survival and the overall patient survival of post-transplant ESRD patients. Further studies that account for factors such as study methodology, donor characteristics, and sample size are needed to reach definitive conclusions. Renal transplant patients with LN should undergo regular follow-up examinations.

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“…6 Furthermore, patient and graft survival rates among SLE patients are similar to those of transplant recipients with other causes of ESKD. 4,5,[7][8][9][10][11][12][13][14][15][16][17][18][19] The recurrence of LN (RLN) in the kidney graft remains a major concern, as it increases the risk of graft loss. [20][21][22] The reported rate of RLN in the graft ranges from 0 to 54%.…”

Section: Introductionmentioning

confidence: 99%

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America

Rodelo

González

Ustáriz

et al. 2021

Lupus

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Objective We assessed patient and graft outcomes and prognostic factors in kidney transplantation in patients with end-stage kidney disease (ESKD) secondary to lupus nephritis (LN) undergoing kidney transplantation from August 1977 to December 2014 in a Latin American single center. Methods The primary endpoint was patient survival, and the secondary endpoints were death-censored graft survival for the first renal transplant and the rate of recurrent LN (RLN). Kaplan–Meier method was used for survival analysis. Factors predicting patient and death-censored graft survivals were examined by Cox proportional-hazards regression analyses. Results 185 patients were retrospectively evaluated. Patient survival rates were 88% at one year, 82% at three years, 78% at five years, and 67% at ten years. Death-censored graft survival for the first renal transplant was 93% at one year, 89% at three years, 87% at five years, and 80% at ten years. RLN was diagnosed in 2 patients (1.08%), but no graft was lost because of RLN. Thirty-nine (21.1%) patients died, and 65 (35.1%) patients experienced graft loss during the follow-up. By multivariable analyses, older recipient age and 1-month posttransplantation eGFR <45 ml/min/1.73m2 were associated with lower patient survival and an increased risk of graft loss, while induction immunosuppressive therapy exerted a protective effect on patients’ survival. In the subgroup of patients in whom disease activity was measured at the time of transplantation, a higher SLEDAI score was also associated with lower patient survival and an increased risk of graft loss. Conclusion In a mostly Mestizo population, kidney transplantation is an excellent therapeutic alternative in LN patients with ESKD. Older recipient age, an eGFR <45 ml/min/1.73m2 at one month posttransplantation, and disease activity at the time of transplantation are predictive of a lower patient and death-censored graft survival, while induction immunosuppressive therapy has a protective effect on patient survival. RLN is rare and does not influence the risk of graft loss.

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Kidney transplantation in systemic lupus erythematosus: Outcomes and prognosis

Cited by 3 publications

References 10 publications

Results and prognosis of kidney transplantation in lupus nephritis: Experience of an Argentine center

Results and prognosis of kidney transplantation in lupus nephritis: Experience of an Argentine center

Graft survival and mortality outcomes after kidney transplant in patients with lupus nephritis: a systematic review and meta-analysis

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America

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