Disciplina de Reumatologia, Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Lupus. 2012 Apr;21(5):570-4. doi: 10.1177/0961203311430220. Epub 2011 Nov 30.
To determine the epidemiological profile and outcome of patients with lupus nephritis (LN) undergoing renal transplantation.
The archival records of 50 patients with LN and end-stage renal disease (ESRD) treated by kidney transplantation from March 1992 to December 2010 were reviewed. All patients met the American College of Rheumatology criteria for systemic lupus erythematosus (SLE).
Fourteen patients were included in the study. The majority were women (85.7%) and non-Caucasian (85.7%); the mean age at diagnosis of SLE and LN was 24 ± 8 and 25 ± 8 years, respectively. Renal biopsy was performed in 12 patients, with 75% of them showing proliferative lesions (class III and IV according to the World Health Organization and International Society of Nephrology/Renal Pathology Society classification). Thirteen patients (93%) underwent intermittent hemodialysis or peritoneal dialysis before transplantation. The median time between the start of dialysis and transplantation was 30 months (range 3-103 months); 67% of the procedures involved deceased donors and 33% involved living-related donors. The graft survival rates were 93.3%, 90.9%, and 85.7% at 1, 5 and 10 years, respectively. Post-transplant immunosuppressive agents were mycophenolate mofetil (84%), azathioprine (17%), tacrolimus (25%), sirolimus (58%) and cyclosporine (8%). Eight episodes of acute rejection were noted in six patients. There was a graft loss due to renal vein thrombosis in the one patient with secondary antiphospholipid syndrome. The mean SLICC by the time of kidney transplantation was 5 ± 2. In total, 13 patients (92.8%) developed at least one infectious event during the follow-up, with one dying in the immediate post-transplant period because of sepsis. Two patients (14%) had a lupus flare. There was no clinical or histological evidence of LN recurrence.
LN is the major cause of morbidity in SLE, with progression to ESRD in 10-22% of cases. Despite concerns about LN recurrence after renal transplantation, the data obtained in our sample indicate this procedure as a safe alternative therapy for ESRD in this population.
确定行肾移植的狼疮肾炎（LN）患者的流行病学特征和结局。
回顾 1992 年 3 月至 2010 年 12 月间行肾脏移植治疗的 50 例 LN 和终末期肾病（ESRD）患者的档案记录。所有患者均符合美国风湿病学会（ACR）系统性红斑狼疮（SLE）的标准。
本研究纳入了 14 例患者。大多数为女性（85.7%）和非白种人（85.7%）；SLE 和 LN 的诊断年龄分别为 24 ± 8 岁和 25 ± 8 岁。12 例患者行肾活检，其中 75%的患者存在增生性病变（根据世界卫生组织和国际肾脏病学会/肾脏病理学会分类，为 III 级和 IV 级）。13 例（93%）患者在移植前行间歇性血液透析或腹膜透析。透析和移植之间的中位时间为 30 个月（3-103 个月）；67%的手术涉及已故供者，33%涉及活体相关供者。移植后 1、5 和 10 年的移植物存活率分别为 93.3%、90.9%和 85.7%。术后免疫抑制剂包括霉酚酸酯（84%）、硫唑嘌呤（17%）、他克莫司（25%）、西罗莫司（58%）和环孢素（8%）。6 例患者中有 8 例出现急性排斥反应。1 例继发抗磷脂综合征患者因肾静脉血栓形成而发生移植物丢失。在接受肾移植时，平均 SLICC 为 5 ± 2。总的来说，13 例（92.8%）患者在随访期间至少发生了 1 次感染事件，1 例患者因败血症在移植后立即死亡。2 例（14%）患者狼疮活动。无 LN 复发的临床或组织学证据。
LN 是 SLE 的主要发病原因，10-22%的患者会进展为 ESRD。尽管对肾移植后 LN 复发存在担忧，但我们样本中的数据表明，该方法是该人群 ESRD 的一种安全替代治疗方法。
