The Long-Term Prognosis of Renal Transplant in Patients With Systemic Vasculitis

Moroni, Gabriella; Torri, Albert; Gallelli, Beniamina; Quaglini, Silvana; Pozzi, Claudio; Banfi, Giovanni; Poli, Francesca; Montagnino, Giuseppe; Ponticelli, Claudio; Piergiorgio, Messa

doi:10.1111/j.1600-6143.2007.01904.x

Cited by 41 publications

(47 citation statements)

References 18 publications

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“…The ANCA pattern or titers at time of transplantation, the duration of the original disease, the duration of dialysis, treatment with cyclosporine, and the source of donors do not influence the risk of recurrence (105,(107)(108)(109), nor are clinical parameters very useful in predicting the risk of recurrence of SVV (108,109). No differences in the rate of recurrence after transplantation was observed between Wegener granulomatosis, microscopic polyarteritis, or renal limited vasculitis (105,108 -110).…”

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%

“…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. Treatment of relapses is mainly based on MPP, cyclophosphamide, and plasmapheresis or possibly rituximab (14,108,115).…”

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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“…It is important to note, however, that 28 of these patients also received induction therapy with ATG, which may have played some role in the low relapse rate observed (40). Regardless, it is clear that the transplanted kidney is not immune to relapse: in one cohort of 19 patients with AAV who were followed for a mean of 45 months after renal transplant, 7 patients experienced a relapse that involved the kidneys, yielding a renal relapse rate of 0.076 per patient per year (41). It is sobering to note that over half of these events occurred during the first 3 months following transplant.…”

Section: How Does the Choice Of Background Immunosuppression Affect Dmentioning

confidence: 99%

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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“…[1][2][3] Data from small case series indicate that recurrence of vasculitis after transplant is infrequent and is rarely associated with graft loss, [4][5][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.…”

Section: Introductionmentioning

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 Long-Term Prognosis of Renal Transplant in Patients With Systemic Vasculitis

Cited by 41 publications

References 18 publications

Recurrence of Secondary Glomerular Disease after Renal Transplantation

Recurrence of Secondary Glomerular Disease after Renal Transplantation

Renal Transplantation in the ANCA-Associated Vasculitides

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