Çeltİk Aygül, Şen Saİt, Tamer Abdülkerİm Furkan, Yılmaz Mümtaz, Sarsık Banu, Özkahya Mehmet, Başçı Alı, Töz Hüseyİn
School of Medicine, Division of Nephrology, Ege University, Izmir, Turkey.
Ege University, School of Medicine, Department of Pathology, Izmir, Turkey.
Nephrology (Carlton). 2016 Jul;21(7):601-7. doi: 10.1111/nep.12657.
Lupus nephritis (LN) is an important complication of systemic lupus erythematosus (SLE). The aim is to use indication and protocol biopsies to determine clinicopathological findings and outcomes of patients with LN undergoing kidney transplantation (KTx).
Patients who underwent KTx due to LN were retrospectively analyzed. Recurrent LN (RLN) was diagnosed by transplant kidney biopsy.
Among 955 KTx patients, 12 patients with LN as the cause of end-stage renal disease were enrolled. Five patients were male. Mean follow-up time was 63 ± 34 months. At the last follow-up visit, mean levels of serum creatinine and proteinuria were 137.0 ± 69.0 µmol/L and 0.26 ± 0.26 g/day, respectively. Eighteen indication and 22 protocol biopsies were performed; 27 biopsies were additionally evaluated by immunofluorescence. In two recipients, subclinical RLN was confirmed by protocol biopsies. Clinical recurrence occurred in four patients. Among patients with RLN, time from diagnosis of LN to KTx was significantly shorter and use of ATG as induction treatment was significantly lower. Graft loss occurred in two recipients who had clinical RLN. Five-year overall graft survival was 85.7%.
Kidney transplantation is a reasonable option for patients with ESRD secondary to SLE. However, recurrence of LN is common if protocol biopsies are included in post-transplantation surveillance.
狼疮性肾炎（LN）是系统性红斑狼疮（SLE）的重要并发症。本研究旨在通过指征性活检和方案性活检来确定接受肾移植（KTx）的LN患者的临床病理特征及预后。
对因LN接受KTx的患者进行回顾性分析。通过移植肾活检诊断复发性LN（RLN）。
在955例KTx患者中，纳入12例因LN导致终末期肾病的患者。其中5例为男性。平均随访时间为63±34个月。在最后一次随访时，血清肌酐和蛋白尿的平均水平分别为137.0±69.0µmol/L和0.26±0.26g/天。共进行了18次指征性活检和22次方案性活检；另外27次活检进行了免疫荧光评估。在2例受者中，方案性活检确诊为亚临床RLN。4例患者发生临床复发。在发生RLN的患者中，从LN诊断到KTx的时间显著缩短，且使用抗胸腺细胞球蛋白（ATG）作为诱导治疗的比例显著降低。2例发生临床RLN的受者出现移植肾失功。5年总体移植肾存活率为85.7%。
对于继发于SLE的终末期肾病患者，肾移植是一种合理的选择。然而，如果在移植后监测中纳入方案性活检，LN复发很常见。
