Division of Nephrology, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA.
J Am Soc Nephrol. 2010 Jul;21(7):1200-7. doi: 10.1681/ASN.2009101093. Epub 2010 May 20.
The frequency and outcome of recurrent lupus nephritis (RLN) among recipients of a kidney allograft vary among single-center reports. From the United Network for Organ Sharing files, we estimated the period prevalence and predictors of RLN in recipients who received a transplant between 1987 and 2006 and assessed the effects of RLN on allograft failure and recipients' survival. Among 6850 recipients of a kidney allograft with systemic lupus erythematosus, 167 recipients had RLN, 1770 experienced rejection, and 4913 control subjects did not experience rejection. The period prevalence of RLN was 2.44%. Non-Hispanic black race, female gender, and age <33 years each independently increased the odds of RLN. Graft failure occurred in 156 (93%) of those with RLN, 1517 (86%) of those with rejection, and 923 (19%) of control subjects without rejection. Although recipients with RLN had a fourfold greater risk for graft failure compared with control subjects without rejection, only 7% of graft failure episodes were attributable to RLN compared and 43% to rejection. During follow-up, 867 (13%) recipients died: 27 (16%) in the RLN group, 313 (18%) in the rejection group, and 527 (11%) in the control group. In summary, severe RLN is uncommon in recipients of a kidney allograft, but black recipients, female recipient, and younger recipients are at increased risk. Although RLN significantly increases the risk for graft failure, it contributes far less than rejection to its overall incidence; therefore, these findings should not keep patients with lupus from seeking a kidney transplant.
在单中心报告中，肾移植受者复发性狼疮肾炎（RLN）的频率和结局有所不同。我们从美国器官共享网络（United Network for Organ Sharing）的档案中，估计了在 1987 年至 2006 年间接受移植的患者中 RLN 的时期患病率和预测因素，并评估了 RLN 对移植物衰竭和受者生存的影响。在 6850 例系统性红斑狼疮肾移植受者中，有 167 例发生 RLN，1770 例发生排斥反应，4913 例对照者未发生排斥反应。RLN 的时期患病率为 2.44%。非西班牙裔黑人种族、女性和年龄<33 岁，每个因素都独立增加了 RLN 的发病几率。在有 RLN 的患者中，156 例（93%）发生移植物衰竭，1517 例（86%）发生排斥反应，923 例（19%）对照者未发生排斥反应。虽然 RLN 组的移植物衰竭风险比无 RLN 组的对照者高 4 倍，但仅有 7%的移植物衰竭归因于 RLN，而 43%归因于排斥反应。在随访期间，867 例（13%）受者死亡：RLN 组 27 例（16%），排斥反应组 313 例（18%），对照组 527 例（11%）。总之，肾移植受者严重 RLN 并不常见，但黑人受者、女性受者和年轻受者的风险增加。尽管 RLN 显著增加了移植物衰竭的风险，但它对其总发生率的贡献远小于排斥反应；因此，这些发现不应阻止狼疮患者寻求肾移植。
