Outcomes in renal transplant recipients with lupus nephritis: experience at a single center

Abstract

Background: The long-term prognosis of renal transplant recipients with systemic lupus erythematosus is still controversial. The outcome of these patients depends on the population studied, race/ethnicity, socioeconomic conditions, donor-related factors and recurrent lupus nephritis (LN), among other factors. Objective: This study was conducted to evaluate kidney transplantation outcomes for adult Brazilian patients with LN at a single center. Subjects and method: The archival records of all patients with LN who had received a kidney transplant at Santa Casa of Sao Paulo Hospítal were reviewed. Kaplan-Meier method was used to determine the survival rate. Results: We identified 18 patients with LN subjected to 22 kidney transplants during the 20-year interval. Two patients received three renal grafts. The majority of the patients were female, with 33.7 ± 10 years at the time of the transplantation, and half of them were African descendants or mixed. Sixteen transplants were performed from deceased donors and six from living-related donors. The patient survival rate was 90%, and graft survival was 68% at 10 years. Chronic allograft nephropathy was the major cause of graft loss. Two patients developed extra-renal manifestations of lupus. There was no clinical or histological evidence of recurrent LN. Conclusion: Renal transplantation is a method which can provide a long-term survival for patients with SLE and end-stage renal disease.

Outcome and Prognosis of Patients With Lupus Nephritis Submitted to Renal Transplantation

“…The long-term prognosis of renal transplantation patients with SLE is a matter of controversy, but some studies have shown patient survival to be similar in graft recipients with and without SLE 6,17–20 . During the 5-year follow-up period of this study, only 5.3% died, matching findings in the literature, including the three Brazilian studies evaluating renal transplantation patients with SLE and LN 8–10,21 .…”

“…In this study we evaluated the clinical and epidemiological characteristics, graft survival time, patient survival and its determinants, and recurrence of SLE in a cohort of LN patients submitted to renal transplantation at our institution between 1996 and 2016, and compared our findings with the national and international literature. To our knowledge, only three other studies on renal transplantation patients with SLE and LN have been conducted in Brazil 8–10 .…”

“…Clinical response of SLE patients to transplantation depends on population, ethnicity, socioeconomic status, donor-related factors and LN recurrence 10 . A study analyzing the outcome and prognostic factors of renal transplantation in LN patients reported 1-year and 5-year graft survival rates of 93.9% and 81.5%, respectively, in agreement with the present study 4 .…”

“…Studies conducted in Brazil have shown good levels of 5-year renal graft survival (81–91%) 8–10 . However, little is known about the prognosis of LN patients submitted to renal transplantation.…”

Cross-matches in Transplantation: Each is Complementary to Other

“…Some studies showed SLE adversely affects the transplant outcome, (8-10) whilst others did not support this. [11][12][13][14][15][16] The largest retrospective study usingUnited StatesRenalData System (USRD) and United Network for Organ Sharing(UNOS) databases showed transplantation in SLE had inferior graft and recipient outcome compared with diabetic ESRD patients. 17 One important consideration regarding SLE is that it might create obstacle from getting CDC cross-match negative donor and render them on long waiting list 18 as in this case, which would have definite adverse prognostic impact on transplant outcome.…”