Renal Transplantation in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Multicenter Experience

Abstract

Background Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a common cause of rapidly progressive glomerulonephritis resulting in end-stage renal disease (ESRD). The optimal timing of kidney transplantation (KTX) for ESRD as a result of AAV and the risk of AAV relapse after KTX are not well defined. We report our experience with AAV patients who underwent KTX at our institutions between 1996 and 2010. Median follow-up was 64 months. Methods Retrospective multicenter cohort study. Results Eighty-five patients (45 men/40 women; mean age 49 years) received a KTX for ESRD secondary to microscopic polyangiitis (n=43) or Wegener’s granulomatosis (n=42). Twenty-four patients underwent preemptive KTX and 69 received a living-donor KTX. All patients were in remission at the time of KTX. Fifty-eight patients received induction therapy. In 64 patients, maintenance immunosuppression was with prednisone, mycophenolate mofetil, and tacrolimus. At the time of KTX, 29 patients were ANCA-positive. The vasculitis relapse rate was 0.02 per patient-years and was not influenced by disease category, ANCA subtype, or remission duration before KTX. There were 23 rejection episodes in 13 patients with seven graft losses. Median serum creatinine at 1 year was 1.3 mg/dL in 75 patients with more than 1 year follow-up and 1.4 mg/dL at last follow-up. The graft and patient survival rates were 100% at 1 year, 97.9% and 93.4% at 5 years, and 79.0% and 67.4% at 10 years, respectively. Conclusions KTX is a safe and an effective option for treating ESRD secondary to AAV. Relapses are rare with current immunosuppression.

L23. Renal transplantation in ANCA-associated vasculitis

“…A general theme in these reports is that AAV patients exhibit survival rates similar to other non-diabetic transplant patients (7). Patient survival rates are as high as 86-93 % five years after transplantation, tending to be better in more recent reports (6). Another consistent finding is that disease phenotype and serotype does not seem to influence survival after transplantation.…”

“…There are several publications reporting on graft and patient survival in AAV (3,(5)(6)(7)(8)(9)(10)(11)(12). A general theme in these reports is that AAV patients exhibit survival rates similar to other non-diabetic transplant patients (7).…”

“…In a similar manner graft outcomes seem to match the results from transplantation in other renal diseases, without obvious differences between granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). In a large registry study 10-year graft survival for GPA patients was 80 % (7), and more recently graft survival censored for death was reported to be as high as 97.9 % after five years in a large multicenter study (6).…”

“…There are several publications clearly indicating that AAV patients do fairly well after renal transplantation and that AAV should definitely not be considered as a contra-indication for transplantation (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). However, there are several issues regarding the treatment of AAV before and after transplantation that remain unresolved which will be addressed in this brief review.…”

De novo myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis 31 years after living-donor kidney transplantation

“…The mortality and recurrence rates were reported to be lower in patients who underwent kidney transplantation compared with the patients on dialysis, possibly because of immunosuppressive therapy [8]. ANCA titers are carefully monitored in patients who undergo kidney transplantation due to ANCA-associated GN.…”