RESEARCH - Risk factors and impact of recurrent lupus nephritis in patients with SLE undergoing renal transplantation

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Arthritis Rheum. 2009 Aug 27;60(9):2757-2766.

Risk factors and impact of recurrent lupus nephritis in patients with

systemic lupus erythematosus undergoing renal transplantation: Data

from a single US institution.

Burgos PI, Perkins EL, Pons-Estel GJ, Kendrick SA, Liu JM, Kendrick

WT, Cook WJ, n BA, Alarcón GS, Kew CE 2nd.

University of Alabama at Birmingham.

OBJECTIVE: To determine the risk factors for recurrent lupus

nephritis, allograft loss, and survival among patients with systemic

lupus erythematosus (SLE) undergoing kidney transplantation.

METHODS: The archival records of all kidney transplant recipients with

a prior diagnosis of SLE (according to the American College of

Rheumatology criteria) from June 1977 to June 2007 were reviewed.

Patients who had died or lost the allograft within 90 days of

engraftment were excluded. Time-to-event data were examined by

univariable and multivariable proportional hazards regression

analyses.

RESULTS: Two hundred twenty of nearly 7,000 renal transplantations

were performed in 202 SLE patients during the 30-year interval. Of the

177 patients who met the criteria for study entry, the majority were

women (80%) and African American (65%), the mean age was 35.6 years,

and the mean disease duration was 11.2 years. Recurrent lupus

nephritis was noted in 20 patients (11%), allograft loss in 69

patients (39%), and death in 36 patients (20%). African American

ethnicity was found to be associated with a shorter time-to-event for

recurrent lupus nephritis (hazard ratio

---

4.63, 95% confidence

interval [95% CI] 1.29-16.65) and death (HR 2.47, 95% CI 0.91-6.71),

although, with the latter, the association was not statistically

significant. Recurrent lupus nephritis and chronic rejection of the

kidney transplant were found to be risk factors for allograft loss (HR

2.48, 95% CI 1.09-5.60 and HR 2.72, 95% CI 1.55-4.78, respectively).

In patients with recurrent lupus nephritis, the lesion in the

engrafted kidney was predominantly mesangial, compared with a

predominance of proliferative or membranous lesions in the native

kidneys.

CONCLUSION: African American ethnicity was independently associated

with recurrent lupus nephritis. Allograft loss was associated with

chronic transplant rejection and recurrence of lupus nephritis.

Recurrent lupus nephritis is infrequent and relatively benign, without

influence on a patient's survival.

PMID: 19714623

http://www.ncbi.nlm.nih.gov/pubmed/19714623

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