M-C Chung1, T-M Yu1, K-H Shu2, J-L Lan3, D-Y Chen4, H-C Ho5, M-J Wu6. 1. Division of Nephrology, Taichung Veterans General Hospital, Taiwan. 2. Division of Nephrology, Taichung Veterans General Hospital, Taiwan; School of Medicine, Chung Shan Medical University, Taiwan. 3. College of Medicine, China Medical University, Taiwan. 4. Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taiwan. 5. Division of Urology, Taichung Veterans General Hospital, Taiwan. 6. Division of Nephrology, Taichung Veterans General Hospital, Taiwan; School of Medicine, Chung Shan Medical University, Taiwan; College of Medicine, China Medical University, Taiwan; Institute of Biomedical Science, National Chung Hsing University, Taiwan; Department of Life Science, Tunghai University, Taiwan. Electronic address: wmj530@gmail.com.
Abstract
BACKGROUND: Kidney transplantation (KT) has better outcome compared with dialysis in lupus patients. The duration lupus patients need to wait before KT remains debatable, especially in patients with lupus activity. We analyzed a renal transplantation database to elucidate if pretransplantation dialysis (PTD) time and lupus activity affected outcome. METHODS: From 1984 to 2012, 31 Chinese lupus nephritis patients underwent KT at our hospital. The lupus activity was defined as nonrenal systemic lupus erythematosus disease activity index (SLE-DAI) score. Biopsy-proven acute rejection/recurrent lupus nephritis (RLN) were recorded. Chronic allograft dysfunction (CAD) was defined as doubling of serum creatinine level. Graft failure was defined as return to dialysis. We calculated relative hazard ratios (HR) with 95% confidence intervals (CI) from Cox proportional-hazards regression models. RESULTS: In total, 31 lupus patients with KT (7 men and 24 women), with a mean age of 35.3 years at transplantation, were enrolled in this study. The mean follow-up duration was 8.2 years. The mean PTD time was 3.3 years. Both PTD time and lupus activity before transplantation had no effect on CAD and graft failure. Longer PTD time was associated with more acute rejection (HR = 1.20; 95% CI, 1.02-1.41). Also, maximal lupus activity after transplantation was associated with more CAD (HR = 6.44; 95% CI, 1.36-30.57). CONCLUSION: For Chinese lupus patients with KT, longer PTD time was associated with worse outcome. Patients should undergo KT immediately if a kidney is available for donation, even with active lupus disease. It is necessary to monitor lupus activity after transplantation due to its effect on outcome. Crown
BACKGROUND: Kidney transplantation (KT) has better outcome compared with dialysis in lupus patients. The duration lupus patients need to wait before KT remains debatable, especially in patients with lupus activity. We analyzed a renal transplantation database to elucidate if pretransplantation dialysis (PTD) time and lupus activity affected outcome. METHODS: From 1984 to 2012, 31 Chinese lupus nephritispatients underwent KT at our hospital. The lupus activity was defined as nonrenal systemic lupus erythematosus disease activity index (SLE-DAI) score. Biopsy-proven acute rejection/recurrent lupus nephritis (RLN) were recorded. Chronic allograft dysfunction (CAD) was defined as doubling of serum creatinine level. Graft failure was defined as return to dialysis. We calculated relative hazard ratios (HR) with 95% confidence intervals (CI) from Cox proportional-hazards regression models. RESULTS: In total, 31 lupus patients with KT (7 men and 24 women), with a mean age of 35.3 years at transplantation, were enrolled in this study. The mean follow-up duration was 8.2 years. The mean PTD time was 3.3 years. Both PTD time and lupus activity before transplantation had no effect on CAD and graft failure. Longer PTD time was associated with more acute rejection (HR = 1.20; 95% CI, 1.02-1.41). Also, maximal lupus activity after transplantation was associated with more CAD (HR = 6.44; 95% CI, 1.36-30.57). CONCLUSION: For Chinese lupus patients with KT, longer PTD time was associated with worse outcome. Patients should undergo KT immediately if a kidney is available for donation, even with active lupus disease. It is necessary to monitor lupus activity after transplantation due to its effect on outcome. Crown
Authors: Laura C Plantinga; Rachel E Patzer; Cristina Drenkard; Michael R Kramer; Mitchel Klein; S Sam Lim; William M McClellan; Stephen O Pastan Journal: Arthritis Care Res (Hoboken) Date: 2015-04 Impact factor: 4.794
Authors: Michelle M O'Shaughnessy; Maria E Montez-Rath; Richard A Lafayette; Wolfgang C Winkelmayer Journal: Nephrol Dial Transplant Date: 2015-11-25 Impact factor: 5.992