Nephrology Dialysis Transplantation, Vol 13, Issue 11 2894-2898, Copyright © 1998 by Oxford University Press
L Azevedo, J Romao, D Malheiros, L Saldanha, L Ianhez and E Sabbaga
Background: Outcome and the issue of recurrence of
disease in systemic lupus erythematosus (SLE) renal transplant recipients
is still a matter of controversy. There is a lack of comparative studies
with non-SLE patients. The aim of this paper is to compare renal
transplantation in lupus patients with a similar matched non-SLE group.
Methods: Forty-five patients with systemic lupus
erythematosus subjected to 48 kidney transplants were studied. For
comparative purposes, a case-control population was selected, matched for
gender, race, type of donor, age, and time of transplantation. Patients
with non-glomerulonephritis diseases were excluded.
Results: No differences in acute episodes of
rejection, causes of kidney loss or patient death were observed. General as
well as infectious complications were similar. Pregnancy rates and outcomes
were similar with no deleterious effect on patients or grafts. Actuarial 1-
and 5-year patient survivals (97.7 and 91.1% for SLE and 95.4 and 87% for
controls, respectively) and graft survivals (93.1 and 80.7% for SLE and
88.8 and 70.2% for controls, respectively) were similar. Long-term renal
function expressed by serum creatinine was the same. No differences in
immunosuppressive drug (azathioprine, prednisone, and cyclosporin)
requirements were found. Clinical SLE recurrence was suspected only once (a
patient with thrombocytopenia, hypocomplementaemia with low complement
levels and positive antiplatelet antibodies). Two SLE patients showed
mesangial proliferative glomerulonephritis compatible with recurrence. Both
grafts were lost. Two further patients showed membranous glomerulonephritis
with an immunofluorescence pattern compatible with recurrence. A fifth
patient had necrotizing arteritis which recovered after treatment with
cyclophosphamide and another patient showed focal and segmental
glomerulosclerosis. Histology of biopsies from five patients in the control
group showed signs compatible with recurrence of focal and segmental
glomerulosclerosis and membranous glomerulonephritis. There was a wide
variation in serum levels of antinuclear antibodies. A wide variation in
complement levels was also observed, but with a tendency toward low C4
levels. Conclusions: The safety of renal
transplantation in SLE patients is equivalent to a matched case-control
group with a similar rate of recurrence of disease. Key
words: renal transplantation; systemic lupus erythematosus
ORIGINAL ARTICLES
Renal transplantation in systemic lupus erythematosus. A case control study of 45 patients
Unidade de Transplante Renal, Hospital das Clínicas, Av Eneas Carvalho Aguiar 255, Caixa Postal 3671, 01060-970 São Paulo-SP, Brazil; Corresponding author
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