Chelamcharla Madhukar, Javaid Basit, Baird Bradley C, Goldfarb-Rumyantzev Alexander S
Division of Nephrology and Hypertension, University of Utah Health Sciences Center, Salt Lake City, UT 84112, USA.
Nephrol Dial Transplant. 2007 Dec;22(12):3623-30. doi: 10.1093/ndt/gfm459. Epub 2007 Jul 19.
Clinical outcome of renal transplantation among systemic lupus erythematosus (SLE) patients remains a topic of controversy. Most of the previous reports were based upon small single-centre studies that were not always well-designed.
We conducted the retrospective analysis using data from USRDS and UNOS databases. Patients were divided into five groups based on the cause of end-stage renal disease (ESRD): diabetes mellitus (DM), SLE, glomerulonephritis, hypertension and other causes. Between 1990 and 1999, 2886 renal transplantation recipients with ESRD due to SLE were identified from a total of 92 844 patients.
The mean follow-up period of this study was 4.7 +/- 2.4 years. While unadjusted analysis using Kaplan-Meier curves demonstrated an association between SLE and improved allograft survival compared with DM, in multivariate analysis the SLE group had worse allograft [hazard ratio (HR) 1.09, P < 0.05] and recipient (HR 1.19, P < 0.05) survival compared with the DM group. Subgroup analysis based on the type of donor showed that SLE patients who received deceased donor allograft had worse allograft and recipient survival (HR 1.14, P = 0.002 and HR 1.30, P = 0.001, respectively) compared with non-SLE deceased donor allograft recipients. Among living allograft recipients, there were no significant differences in either allograft or recipient survival compared with non-SLE recipients.
SLE as a cause of ESRD in renal transplant recipients is associated with worse allograft and recipient survival compared with DM; this association is true for the entire population and for the recipients of deceased donor (but not living donor) transplant. Deceased donor allograft recipients have worse outcomes compared with living allograft recipients.
系统性红斑狼疮（SLE）患者肾移植的临床结局仍是一个有争议的话题。以前的大多数报告基于小型单中心研究，这些研究设计并不总是完善。
我们使用美国肾脏数据系统（USRDS）和器官共享联合网络（UNOS）数据库的数据进行回顾性分析。根据终末期肾病（ESRD）病因将患者分为五组：糖尿病（DM）、SLE、肾小球肾炎、高血压和其他病因。1990年至1999年期间，从总共92844例患者中确定了2886例因SLE导致ESRD的肾移植受者。
本研究的平均随访期为4.7±2.4年。虽然使用Kaplan-Meier曲线进行的未调整分析表明，与DM相比，SLE与移植肾存活率提高相关，但在多变量分析中，与DM组相比，SLE组的移植肾[风险比（HR）1.09，P<0.05]和受者（HR 1.19，P<0.05）存活率更差。基于供体类型的亚组分析表明，与非SLE尸体供肾移植受者相比，接受尸体供肾移植的SLE患者的移植肾和受者存活率更差（HR分别为1.14，P = 0.002和HR 1.30，P = 0.001）。在活体肾移植受者中，与非SLE受者相比，移植肾或受者存活率均无显著差异。
与DM相比，SLE作为肾移植受者ESRD的病因与移植肾和受者存活率更差相关；这种关联在整个人群以及尸体供肾（而非活体供肾）移植受者中均成立。与活体肾移植受者相比，尸体供肾移植受者的结局更差。
