Renal transplantation in lupus nephritis

Abstract

Most patients with systemic lupus erythematosus (SLE) are suitable candidates for renal transplantation. However, a number of them may present some disease-related problems. As cardiovascular disease is a leading cause of morbidity and mortality in SLE patients, a careful pretransplant cardiovascular screening is recommended. A search for antiphospholipid antibodies is also useful as the presence of these antibodies can cause an early graft thrombosis. The risk of recurrence of SLE nephritis after transplantation may range between 2 and 30%. In most cases recurrence is characterized by mild histologic lesions. Only rarely does it lead to graft failure. Postransplant immunosuppression does not differ from that used routinely. Whenever possible, a steroid-free immunosuppression should be scheduled to prevent iatrogenic toxicity in patients who have already received long-term steroid treatment. The results of kidney transplantation largely depend on the clinical conditions at transplantation. In patients with poor clinical status or receiving an aggressive immunosuppression it is advisable to postpone the transplant. When some selection criteria are respected, the results of renal trasplantation in SLE patients are at least as good as in other transplant recipients.

A comprehensive review of the clinical approach to pregnancy and systemic lupus erythematosus

“…After transplantation there is usually a low rate of recurrence of LN, therefore pregnancy could be a hypothesis for these women [73]. Pregnancies post-transplant are generally successful, but with an increased risk of several severe maternal and neonatal complications, such as miscarriages, pre-eclampsia, premature birth with low birth weight [74,75], while no renal complications were recorded [75].…”

Impact of recurrent lupus nephritis on lupus kidney transplantation

“…Although a comparable survival rate has been reported [2][3][4][5], the recurrence of lupus nephritis (RLN) remains a concern [6][7][8][9][10][11][12] because SLE is a systemic disease with a plethora of auto-antibodies which may be detrimental to the renal allograft [13,14]. With the development of newer more potent immunosuppresants, it was believed that the recurrence would become uncommon.…”

Renal Transplantation in Systemic Lupus Erythematosus: Outcome and Prognostic Factors in 50 Cases from a Single Centre

“…Recent surveys indicate that renal transplantation is associated with good outcomes in patients with ESRD due to lupus nephritis that are, in general, similar to transplant recipients with ESRD due to other causes [13, 14]. Of note, some factors of the recipient have been associated with poor outcome such as the black race, the positivity of anti-phospholipid antibodies (aPL), the peritoneal dialysis, the poor clinical conditions at the time of transplantation, and the poor treatment compliance [13, 14].…”

“…Of note, some factors of the recipient have been associated with poor outcome such as the black race, the positivity of anti-phospholipid antibodies (aPL), the peritoneal dialysis, the poor clinical conditions at the time of transplantation, and the poor treatment compliance [13, 14]. In addition, longer pretransplantation dialysis period was associated with more acute rejection in a series of Chinese SLE patients [15].…”