P1703results of Renal Transplantation in Patients With Rheumatic Diseases

Abstract

Background and Aims Rheumatic diseases often involve the kidneys and it might lead to chronic kidney disease (CKD). In its final stage it must be treated with renal replacement methods such as dialysis (hemodialysis or peritoneal dialysis) or renal transplantation. Kidney transplantation is the preferred and most cost-effective treatment for the end-stage renal disease, it offers a better quality of life than dialysis. The most common types of renal pathology in rheumatic diseases include glomerular (systemic lupus erythematosus), vascular (ANCA-associated vasculitides) and tubulointerstitial (goat) diseases. According to a research conducted in 2010 at the Minsk Rheumatological Department, 25% of patients had clinical or laboratory features of CKD. The aims were to reveal the most frequent rheumatic diseases affecting the kidneys and evaluate the post-transplant period in these patients. Method 94 medical case were studied retrospectively. All these patients had the end-stage renal disease with GFR of <15 ml/min/1.73m2 and underwent renal transplantation between January 2011 and September 2019. Results A retrospective study of 94 kidney transplant patients was conducted on renal transplantation centers in Belarus. Among the patients that underwent renal transplantation from January 2011 till September 2019, the percentage of recipients with rheumatic diseases was 3.64%. The majority of the recipients (52 %) were females. The mean age was 44.36 years (range, 16-78 years). Of the sample, 90% of kidney allografts were received from brain-dead donors, whereas only 10% of recipients got a new kidney from living-donors. Systemic lupus erythematosus was the most common causative disease in patients with rheumatic diseases (31 cases, 33%) followed by goat (28 cases, 30%) and secondary amyloidosis (17 cases, 18%) that complicated the course of rheumatoid arthritis and seronegative spondylarthritis. The remaining part of patients suffered from ANCA-associated vasculitides (10 cases, 10.6%), anti-glomerular basement membrane disease (6 cases, 6.4%), and single cases were represented by progressive systemic sclerosis and antiphospholipid syndrome (2%). In the post-transplant period, the most common complications were arterial hypertension (38%), anemia (20%), infectious diseases (27%), among them the most frequent were urinary tract infection (20%) and cytomegalovirus infection (7%). The 1-year allograft survival rate was 86%, the 5-year rate was about 82%. The main reasons for failed outcomes were acute renal allograft rejection, postoperative complications and infection. The patient survival rate after 1 and 5 years after transplantation was 93% and 86%, respectively. Infectious diseases (44%) such as nosocomial pneumonia, sepsis and cardiovascular disease (33%) are still the two most important reasons of death. Conclusion 1. The most common rheumatic diseases causing the end-stage renal disease are systemic lupus erythematosus (33%), goat (30%), rheumatoid arthritis, and seronegative spondylarthritis that lead to secondary amyloidosis (18%). 2. The 1-year allograft survival rate was 86%, the 5-year rate was about 82%, the patient survival rate after 1 and 5 years after transplantation was 93% and 86%, respectively. 3. The survival of patients with rheumatic diseases who underwent renal transplantation is comparable to patient survival after transplantation with another kidney pathology. 4. The main causes of death following renal transplantation are infectious and cardiovascular complications. Acute renal allograft rejection, postoperative complications, and infection are the main reasons of allograft failure.