Renal transplantation in systemic vasculitis: when is it safe?

Little, Mark A.; Hassan, Basma Badr; Jacques, Steve; Game, David; Salisbury, Emma; Courtney, Aisling E.; Brown, Catherine; Salama, Alan D.; Harper, Lorraine

doi:10.1093/ndt/gfp347

Cited by 68 publications

(65 citation statements)

References 23 publications

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“…In an abstract, the CTS (113) reported a 10-year patient survival of 80% and a graft survival of 65% for renal transplant recipients with Wegener granulomatosis. Relapses of SVV seldom occur after renal transplantation (101,102,109,110), perhaps because of concomitant immunosuppression.…”

Section: Small Vessel Vasculitismentioning

confidence: 99%

“…Because clinical re-mission of SVV for Ͻ1 year is associated with a high mortality rate (103,110), SVV candidates for renal transplantation should be in stable clinical remission at the time of transplantation. Prolonged immunosuppression may also expose patients to the risk of life-threatening infections after transplantation (114); thus, we believe that transplantation should be delayed for several months after starting dialysis in patients who have received a prolonged or intense period of immunosuppression for treatment of their underlying disease (108).…”

Section: Small Vessel Vasculitismentioning

confidence: 99%

“…Persistent positivity of ANCA tests should not preclude transplantation (100,110). A careful monitoring of the urinary sediment during the first few years after transplantation may help in making a prompt diagnosis and treatment of a recurrence or relapse of SVV.…”

Section: Small Vessel Vasculitismentioning

confidence: 99%

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Recurrence of Secondary Glomerular Disease after Renal Transplantation

Ponticelli¹,

Moroni

Glassock

2011

Clinical Journal of the American Society of Nephrology

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SummaryThe risk of a posttransplant recurrence of secondary glomerulonephritis (GN) is quite variable. Histologic recurrence is frequent in lupus nephritis, but the lesions are rarely severe and usually do not impair the longterm graft outcome. Patients with Henoch-Schonlein nephritis have graft survival similar to that of other renal diseases, although recurrent Henoch-Schonlein nephritis with extensive crescents has a poor prognosis. Amyloid light-chain amyloidosis recurs frequently in renal allografts but it rarely causes graft failure. Amyloidosis secondary to chronic inflammation may also recur, but this is extremely rare in patients with Behcet's disease or in those with familial Mediterranean fever, when the latter are treated with colchicine. Double organ transplantation (liver/kidney; heart/kidney), chemotherapy, and autologous stem cell transplantation may be considered in particular cases of amyloidosis, such as hereditary amyloidosis or multiple myeloma. There is little experience with renal transplantation in light-chain deposition disease, fibrillary/ immunotactoid GN, or mixed cryoglobulinemic nephritis but successful cases have been reported. Diabetic nephropathy often recurs but usually only after many years. Recurrence in patients with small vessel vasculitis is unpredictable but can cause graft failure. However, in spite of recurrence, patient and graft survival rates are similar in patients with small vessel vasculitis compared with those with other renal diseases. Many secondary forms of GN no longer represent a potential contraindication to renal transplantation. The main issues in transplantation of patients with secondary GN are the infectious, cardiovascular, or hepatic complications associated with the original disease or its treatment.

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Section: Small Vessel Vasculitismentioning

confidence: 99%

Section: Small Vessel Vasculitismentioning

confidence: 99%

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Recurrence of Secondary Glomerular Disease after Renal Transplantation

Ponticelli¹,

Moroni

Glassock

2011

Clinical Journal of the American Society of Nephrology

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“…According to the literature, RT should be offered to patients with vasculitis because they have better graft and patient survival than other kidney transplant recipients. 9 There are a number of published reports indicating that RT is an excellent option for treating patients with ANCA-associated vasculitis who develop ESRD. 10 In our series, we observed 3 patients with GPA who had a good graft outcome and good patient survival rates.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Barbouch

Hajji²,

Aoudia³

et al. 2017

Exp Clin Transplant

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Objectives: End-stage renal disease develops in a high percentage of patients with vasculitis, in whom kidney transplant has become a therapeutic option. However, limited data are available on the prognosis and outcomes after kidney transplant in these patients. We aimed to compare the long-term graft survival and graft function in 8 renal transplant recipients with vasculitis (granulomatosis with polyangiitis, microscopic pol yangiitis, Goodpasture syndrome, and Henoch-Schönlein purpura) with the other kidney recipients at a single center. Materials and Methods:We conducted a retrospective study of patients followed for chronic renal failure associated with vasculitis before renal transplant. We excluded patients with no biopsy-proven nephropathy. Results: There was no difference in the occurrence of metabolic and cardiovascular complications in our case group compared with the other graft recipients. Infections were frequent and included cytomegalovirus and urinary tract infection. The rates of bacterial and viral infection were equivalent in our population. The incidence of allograft loss was estimated at 1.8%, less than that seen in our entire transplant population. The presence of vasculitis was not significantly related to renal failure (P = .07). Extrarenal relapse occurred in 1 patient with microscopic polyangiitis. Antineutrophil cytoplasmic antibody levels in patients with granulomatosis with polyangiitis and microscopic polyangiitis did not seem to influence the renal outcome (P = .08). Circulating antineutrophil cytoplasmic antibodies were associated with the development of vascular lesions in the graft but were not significantly correlated with graft survival (P = .07). Conclusions: This study supports the theory that renal transplant is an effective treatment option for patients with end-stage renal disease secondary to vasculitis. These patients fare similarly to, if not better than, other patients. Key words: Antibodies, Antiglomerular basement membrane disease, Antineutrophil cytoplasmic, Prognosis, Purpura, Schoenlein-Henoch IntroductionRenal vasculitis results in end-stage renal disease in 20% to 40% of patients. 1-3 Data from small case series indicate that recurrence of vasculitis after transplant is infrequent and is rarely associated with graft loss, 4-6 whereas relapse rates are below those reported in the entire transplant population. 7 We aimed to highlight the outcome of renal transplant (RT) in a case series of 8 patients with renal vasculitis followed at a single transplant unit. Materials and MethodsOur cohort of 8 patients included 3 patients diagnosed with granulomatosis with polyangiitis (GPA), 1 with microscopic polyangiitis (MPA), 2 with Goodpasture syndrome, and 2 with Henoch-Schönlein purpura (HSP). All patients were treated between 1986 and 2015, and all relevant data were gathered using patient record review. We compared vasculitis patients with all other patients who underwent RT at our center to determine the correlation between vasculitis and the occurrence of me...

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“…The reported patient and graft outcomes after kidney transplant in AAV have been comparable to those with other primary renal diseases. [5][6][7] The timing of transplant is considered to be safe after at least 12 months from remission due to the high risk of disease recurrence. 7 In this case series, we present patient and allograft outcomes in patients with AAV who received a kidney transplant in the East of Scotland.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Buttigieg

Henderson

Kidder

2017

Exp Clin Transplant

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Objectives: Kidney transplant outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis are comparable with outcomes in patients transplanted for other causes. Here, we report our single center experience of kidney transplant in patients with this condition and a pooled analysis of published studies. Materials and Methods: This retrospective study included all patients with end-stage kidney disease secondary to antineutrophil cytoplasmic antibodyassociated vasculitis who received a kidney transplant between 1987 and 2013 in the East of Scotland. We examined patient and graft survival and disease recurrence after transplant. We also performed a pooled analysis of published literature. Results: We identified 24 patients who received a total of 31 kidney allografts. Median age at first transplant was 45.5 years (range, 18-68 y), and median follow-up after transplant was 60 months (range, 0.5-226 mo). All patients were positive for antineutrophil cytoplasmic antibody (71% by proteinase 3 and 29% by myeloperoxidase) at diagnosis. Patient survival at 1 and 5 years was 92% and 88%, with corresponding death-censored allograft survival of 93% and 71%. Overall patient and allograft relapse rates were 0.022 and 0.016 relapse/patient-years. The pooled analysis comprised 20 studies (1169 patients). Patient/graft survival ranged from 64% to 80%/77% to 100% at 5 years and from 60% to 100%/59% to 84% at 10 years. Relapse rate was significantly higher in patients with positive antineutrophil cytoplasmic antibody at transplant (14% vs 5%; P = .042). Conclusions: Our experience shows that kidney transplant remains a safe option for patients with endstage kidney disease secondary to antineutrophil cytoplasmic antibody-associated vasculitis. Disease relapse posttransplant is uncommon and associated with pretransplant relapse. Pooled analyses suggest that relapse rate is higher in patients with positive antineutrophil cytoplasmic antibody at transplant. Multicenter registry data are needed to define renal outcome predictors in antineutrophil cytoplasmic antibody-associated vasculitis.

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Renal transplantation in systemic vasculitis: when is it safe?

Cited by 68 publications

References 23 publications

Recurrence of Secondary Glomerular Disease after Renal Transplantation

Recurrence of Secondary Glomerular Disease after Renal Transplantation

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