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Long-term survival of renal transplantation in patients with lupus nephritis: experience from a single university centre


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11

 

  1. Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology, and Internal Medicine Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
  2. Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology, and Internal Medicine Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
  3. Nephrology Division, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
  4. Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology, and Internal Medicine Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
  5. Nephrology Division, Hospital Universitario Marqués de Valdecilla, Santander, and University of Cantabria, School of Medicine, Santander, Spain.
  6. Nephrology Division, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
  7. Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
  8. Rheumatology Department, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-Roche (EPID-Future), Universidad Autónoma de Madrid, Spain.
  9. Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology and Internal Medicine Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, and University of Cantabria, School of Medicine, Santander, Spain; and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  10. Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology and Internal Medicine Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, and University of Cantabria, School of Medicine, Santander, Spain. hernandezjluis@gmail.com
  11. Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology and Internal Medicine Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, and University of Cantabria, School of Medicine, Santander, Spain. rblanco@humv.es

CER14213
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PMID: 34665698 [PubMed]

Received: 11/11/2020
Accepted : 15/03/2021
In Press: 13/10/2021

Abstract

OBJECTIVES:
Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE). Unfortunately, 10–20% of patients with LN develop end-stage renal disease (ESRD), and renal transplantation may be a therapeutic option. However, concerns about LN recurrence after transplant have been reported. We aimed to assess long-term post-transplant graft and patient survival in LN compared to patients with non-autoimmune nephropathy (polycystic kidney disease - PCKD).
METHODS:
We carried out a single-centre retrospective study of all patients who underwent renal transplantation due to LN in a referral unit between 1980 and 2018. This cohort was compared with a group of PCKD patients. The main outcome variables were graft and patient survival for up to 20 years, and the time-course of serum creatinine and proteinuria in the first 5 years after transplantation. Cumulative survival rates were estimated by the Kaplan-Meier method and compared using the log-rank test.
RESULTS:
We included 53 patients: LN group (n=21) and PCKD group (n=32). Baseline clinical characteristics were similar in both groups, except age at transplantation (39.8±11.3 years in the LN group and 46.6±5.0 years in the PCKD group; p=0.004). No significant differences were found regarding graft (p=0.59) or patient survival (p=0.087) at 20 years of follow-up.
CONCLUSIONS:
Despite concerns about LN recurrence after renal transplantation, this study shows that this procedure might be a safe alternative therapy for ESRD related to SLE and may provide long-term survival.

Rheumatology Article