系统性红斑狼疮患者的肾移植：移植肾存活率与其他终末期肾病病因的比较。
Renal transplantation in systemic lupus erythematosus: Comparison of graft survival with other causes of end-stage renal disease.
作者信息
Horta-Baas Gabriel, Camargo-Coronel Adolfo, Miranda-Hernández Dafhne Guadalupe, Gónzalez-Parra Leslie Gabriela, Romero-Figueroa María Del Socorro, Pérez-Cristóbal Mario
机构信息
Servicio de Reumatología, Hospital General Regional 220 «Gral. José Vicente Villada», Instituto Mexicano del Seguro Social, Toluca de Lerdo, Estado de México, México.
Servicio de Reumatología, UMAE, Hospital de Especialidades «Dr. Bernardo Sepúlveda Gutiérrez», Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
出版信息
Reumatol Clin (Engl Ed). 2019 May-Jun;15(3):140-145. doi: 10.1016/j.reuma.2017.07.006. Epub 2017 Aug 14.
INTRODUCTION
End-stage renal disease (ESRD) due to lupus nephritis (LN) occurs in 10%-30% of patients. Initially systemic lupus erythematosus (SLE) was a contraindication for kidney transplantation (KT). Today, long-term graft survival remains controversial. Our objective was to compare the survival after KT in patients with SLE or other causes of ESRD.
METHODS
All SLE patients who had undergone KT in a retrospective cohort were included. Renal graft survival was compared with that of 50 controls, matched for age, sex, and year of transplantation. Survival was evaluated by the Kaplan-Meier test and the Cox proportional hazards model.
RESULTS
Twenty-five subjects with SLE were included. The estimated 1-year, 2- and 5-year survival rates for patients with SLE were 92%, 66% and 66%. Renal graft survival did not differ between patients with SLE and other causes of ESRD (P=.39). The multivariate analysis showed no significant difference in graft survival between the two groups (hazard ratio, HR=1.95, 95% confidence interval [CI] 0.57-6.61, P=.28). The recurrence rate of LN was 8% and was not associated with graft loss. Acute rejection was the only variable associated with graft loss in patients with SLE (HR=16.5, 95% CI 1.94-140.1, P=.01).
CONCLUSIONS
Renal graft survival in SLE patients did not differ from that reported for other causes of ESRD.
引言
狼疮性肾炎（LN）导致的终末期肾病（ESRD）发生在10%-30%的患者中。最初，系统性红斑狼疮（SLE）是肾移植（KT）的禁忌证。如今，长期移植物存活仍存在争议。我们的目的是比较SLE患者与其他ESRD病因患者肾移植后的存活率。
方法
纳入回顾性队列中所有接受肾移植的SLE患者。将肾移植物存活率与50名年龄、性别和移植年份相匹配的对照组进行比较。通过Kaplan-Meier检验和Cox比例风险模型评估存活率。
结果
纳入25名SLE患者。SLE患者的1年、2年和5年估计存活率分别为92%、66%和66%。SLE患者与其他ESRD病因患者的肾移植物存活率无差异（P = 0.39）。多因素分析显示两组间移植物存活率无显著差异（风险比，HR = 1.95，95%置信区间[CI] 0.57 - 6.61，P = 0.28）。LN复发率为8%，且与移植物丢失无关。急性排斥是SLE患者中与移植物丢失相关的唯一变量（HR = 16.5，95% CI 1.94 - 140.1，P = 0.01）。
结论
SLE患者的肾移植物存活率与其他ESRD病因患者的报告结果无差异。
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