Renal Transplantation in Patients with Microscopic Polyarteritis and Antimyeloperoxidase Antibodies: Report of Three Cases

Frascà, Giovanni M.; Neri, Loris; Martello, Mauro; Sestigiani, Elena; Borgnino, Luigi Carlo; Bonomini, V.

doi:10.1159/000188811

Cited by 18 publications

(12 citation statements)

References 4 publications

(7 reference statements)

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“…Transplanted AAV patients also have lower vasculitis relapse rates compared with those who remain on dialysis (6, 9–12). A mean 10-year graft survival of 65.4% has been reported for patients with WG, which compares favorably with graft survival observed in other nonsystemic inflammatory conditions (13); however, as many as 50% of cases have been said to suffer a vasculitis relapse after KTX, and this may adversely affect allograft outcome (3, 4, 14–21). A pooled analysis of 127 patients reported in 1999 indicated that AAV recurred in 17.3% of patients after KTX (22).…”

mentioning

confidence: 79%

“…Lionaki et al (26) reported a vasculitis relapse rate of 0.08 episodes per person year in 93 patients with AAV on dialysis and a vasculitis relapse rate of 0.16 episodes per person year in 359 patients in AAV patients with renal involvement who had not reached ESRD. There has been, however, great variability regarding relapse rates in AAV patients after KTX (3, 14–20). A pooled analysis by Nachman et al (22), reported an overall relapse rate of 17%, with an average time from KTX to relapse of 31 months.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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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.

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confidence: 79%

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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“…7,10-13 However, relapses of AAV have been reported in as many as 50% of cases following KTx and may adversely affect allograft outcome. 4,5,[14][15][16][17][18][19][20][21] A pooled analysis of 127 patients indicated that AAV recurred in 17.3% of patients after KTx. 22 The majority of these patients (65%) received cyclosporin A (CsA) and specific data about immunosuppression were not available in the rest.…”

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confidence: 99%

Recurrence of ANCA-associated vasculitis following renal transplantation in the modern era of immunosupression

Gera

Griffin

Specks

et al. 2007

Kidney International

107

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Progressive glomerulonephritis and attendant end-stage renal disease (ESRD) result from antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. The optimum time of kidney transplantation in patients with ESRD due to ANCA-associated vasculitis (AAV) and the risk of renal or nonrenal recurrence of vasculitis after transplantation are unknown. To answer some of these questions, we followed 35 transplant recipients with diagnoses of microscopic polyangiitis (20 patients) and Wegener's granulomatosis (15 patients). The median time from diagnosis to transplantation was 25 months with all patients being in clinical remission. Fifteen patients were ANCA-positive at time of the transplant with 13 preemptive transplants. The most common immunosuppressive strategy included antibody induction, corticosteroid, mycophenolate mofetil, and tacrolimus with acute rejection occurring in eight cases. Overall and death-censored graft survivals were 94 and 100%, respectively, 5 years post-transplantation. Nonrenal relapse occurred in three patients with a satisfactory response to treatment. No clear risk factor to relapse emerged and no detrimental effect to renal function was found. We conclude that transplantation should be considered as the treatment of choice for ESRD due to AAV. Potent antirejection regimes are well tolerated in these patients, are associated with a low risk of recurrence and an absence of AAV-related graft dysfunction.

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“…Several groups have reported successful transplantation in both WG and MPA patients with positive ANCA (10,13,(26)(27)(28)(29). C-ANCA was detectable in 8 of 12 WG patients at the time of transplantation in the study by Schmidt et al (12), and in 7 of 8 patients in a case series by Rostaing et al (30).…”

Section: Does a Positive Anca Preclude Renal Transplant?mentioning

confidence: 98%

Renal Transplantation in the ANCA-Associated Vasculitides

Geetha

Seo

2007

American Journal of Transplantation

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Despite advances in the diagnosis and treatment of the antineutrophil cytoplasmic autoantibodies (ANCA)-associated vasculitides, renal morbidity is common. End-stage renal disease occurs in up to 20% of patients with these diagnoses, which include Wegener's granulomatosis and microscopic polyangiitis. As the mortality of patients with ANCA-associated vasculitis continues to improve, our ability to address the consequences of renal failure in this patient population becomes paramount. Renal transplantation is an important therapeutic option for these patients. Graft and patient survival rates among patients with ANCA-associated vasculitis are comparable to those observed in nondiabetic patients. This review summarizes our current knowledge of indications and contraindications for renal transplantation in these patients, the recurrence of vasculitis after transplantation and the impact of posttransplant immunosuppression on the clinical course of these patients.

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Renal Transplantation in Patients with Microscopic Polyarteritis and Antimyeloperoxidase Antibodies: Report of Three Cases

Cited by 18 publications

References 4 publications

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

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

Recurrence of ANCA-associated vasculitis following renal transplantation in the modern era of immunosupression

Renal Transplantation in the ANCA-Associated Vasculitides

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