Evaluation of Renal Grafts in Patients With Lupus Nephritis as Cause of End-Stage Renal Disease

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Abstract

Introduction

Kidney transplantation is the best option in end-stage renal disease (ESRD). For many years patients affected with lupus nephritis have had poor graft results. However, this has been changing over recent years with the development of new immunosuppressive drugs and a better comprehension of the natural evolution of the entity.

Methods

We studied 20 patients with lupus nephritis who received 22 kidney grafts: 15 women and five men (n = 11) who were treated with cyclosporine or with tacrolimus (n = 11). Secondary immunosuppression included mycophenolate match (MMF) (n = 13) or azathioprine (n = 9). We analyzed human leukocyte antigen, cold ischemia time, acute tubular necrosis, creatinine, cholesterol, triglycerides, glucose, blood pressure, acute rejection episodes, immunosuppression, infections, disease recurrences, as well as graft and patient survival.

Results

After a mean cold ischemia time of 22 ± 4 hours, nine patients displayed delayed graft function of an average duration 9 ± 4 days. At 36 ± 35 months nine grafts were lost: two due to acute rejection; five to chronic allograft nephropathy; and two to venous thrombosis. One patient died of hemorrhagic shock. There were five cytomegalovirus infections. Graft survival was dependent on the type of secondary immunosuppression, incidence of acute rejection episodes and occurrence of delayed graft function.

Conclusions

We found no clinical recurrence of lupus nephritis after transplantation and a low incidence of complications, although there was a trend toward thrombosis. The presence of delayed graft function, episodes of acute rejection, and receiving azathioprine instead of MMF as secondary immunosuppression were associated with poorer graft survival.

Section snippets

Methods

We studied 20 patients (15 women and five men) with ESRD due to lupus nephritis who received 22 transplants. Their mean age was 34 ± 8 years, time on dialysis before transplantation 21 ± 19 months, and duration of SLE, 9 ± 4 years. The cold ischemia time was 22 ± 4 hours. All the patients received the graft from a cadaveric donor and all received corticosteroids and a primary immunosuppressant (11 patients cyclosporine [CsA] vs 11 patients tacrolimus) plus a secondary immunosuppressant (13

Results

At a mean follow-up of 36 ± 35 months (1 to 120 months), we observed a temporal relation between the secondary immunosuppressant, with a trend toward benefit of MMF. Eight patients suffered delayed graft function (38%), with a mean duration of 9 ± 4 days. Nine grafts were lost: two because of acute rejection; two, venous thrombosis; and five, chronic allograft nephropathy. One patient died of hemorrhagic shock soon after transplantation. There were five cases of cytomegalovirus infection and no

Discussion

Renal transplantation among patients with ESRD caused by lupus nephritis has become an accepted alternative for long-term treatment. The outcome of renal transplantation in patients with systemic lupus erythematosus is still controversial. Infection, recurrent disease, acute and chronic rejection, as well as thrombosis may play a role in early graft loss. Our study showed poorer graft survival among patients with acute rejection episodes and delayed graft function. Several authors, such as

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