Goral Simin, Ynares Christina, Shappell Scott B, Snyder Shannon, Feurer Irene D, Kazancioglu Rumeyza, Fogo Agnes B, Helderman J Harold
Renal, Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6144, USA.
Transplantation. 2003 Mar 15;75(5):651-6. doi: 10.1097/01.TP.0000053750.59630.83.
Although recurrent lupus nephritis (RLN) after kidney transplantation is reported to be rare (1%-4%), recent studies suggest a higher incidence. The purpose of this study was to determine the incidence of RLN in a large cohort of renal transplant recipients with systemic lupus erythematosus (SLE).
The records of 54 renal transplant recipients with SLE were reviewed. Thirty-one patients underwent biopsy because of worsening renal function and proteinuria. All biopsy specimens were evaluated by light microscopy, immunofluorescence (IF), and electron microscopy (EM).
Among the 50 patients with at least 3 months of follow-up, RLN was present in 15 (52% of patients who underwent biopsy, 30% of total patients): mesangial lupus nephritis (LN) (class II) in eight, focal proliferative LN (class III) in four, and membranous LN (class Vb) in three patients. One patient had graft loss because of RLN (class II) at 10.5 years. The duration of dialysis before transplantation was not different between patients with RLN compared to patients without RLN (P=0.40). Overall patient survival (n=50) was 96% at 1 year and 82% at 5 years, and graft survival was 87% at 1 year and 60% at 5 years. Graft survival was worse in patients who underwent biopsy compared with patients who never underwent biopsy (P<0.01).
RLN is more common than previously reported, but in our series, graft loss because of RLN was rare. Aggressive use of allograft biopsies and morphologic evaluation with IF and EM are important factors in the diagnosis of RLN. The impact of new immunosuppressive agents on the incidence of RLN remains to be seen.
尽管肾移植后复发性狼疮性肾炎（RLN）的报道较为罕见（1%-4%），但近期研究表明其发病率更高。本研究的目的是确定一大群系统性红斑狼疮（SLE）肾移植受者中RLN的发病率。
回顾了54例SLE肾移植受者的记录。31例患者因肾功能恶化和蛋白尿接受了活检。所有活检标本均通过光镜、免疫荧光（IF）和电子显微镜（EM）进行评估。
在50例至少随访3个月的患者中，15例存在RLN（接受活检患者的52%，总患者的30%）：8例为系膜性狼疮性肾炎（LN）（II级），4例为局灶增生性LN（III级），3例为膜性LN（Vb级）。1例患者在10.5年时因RLN（II级）导致移植肾丢失。移植前透析时间在有RLN的患者和无RLN的患者之间无差异（P=0.40）。总体患者生存率（n=50）在1年时为96%，5年时为82%，移植肾生存率在1年时为87%，5年时为60%。与未接受活检的患者相比，接受活检的患者移植肾生存率更差（P<0.01）。
RLN比先前报道的更常见，但在我们的系列研究中，因RLN导致的移植肾丢失很少见。积极进行移植肾活检以及采用IF和EM进行形态学评估是RLN诊断的重要因素。新型免疫抑制剂对RLN发病率的影响仍有待观察。
