Ramirez-Sandoval J C, Chavez-Chavez H, Wagner M, Vega-Vega O, Morales-Buenrostro L E, Correa-Rotter R
1 Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.
2 Department of Medicine, Weill Cornell Medical College, New York, United States.
Lupus. 2018 Jul;27(8):1303-1311. doi: 10.1177/0961203318770527. Epub 2018 Apr 26.
Kidney transplant for patients with lupus nephritis (LN) has satisfactory outcomes in studies with short-term or mid-term follow up. Nevertheless, information about long-term outcomes is scarce. We performed a retrospective matched-pair cohort study in 74 LN recipients compared with 148 non-LN controls matched by age, sex, immunosuppressive treatment, human leukocyte antigen (HLA) matches, and transplant period in order to evaluate long-term outcomes of kidney transplant in LN recipients. Matched pairs were predominantly females (83%), median age at transplant surgery of 32 years (interquartile range 23-38 years), and 66% received a graft from a living related donor. Among LN recipients, 5-, 10-, 15-, and 20-year graft survival was 81%, 79%, 57% and 51%, respectively, and it was similar to that observed in controls (89%, 78%, 64%, and 56%, respectively). Graft loss (27% vs. 21%, p = 0.24) and overall survival ( p = 0.15) were not different between LN recipients and controls. Also, there was no difference in episodes of immunological rejection, thrombosis, or infection. Only six LN recipients had biopsy-proven lupus recurrence and three of them had graft loss. In a cohort with a long follow up of kidney transplant recipients, LN recipients had similar long-term graft survival and overall outcomes compared with non-lupus recipients when predictors are matched between groups.
在短期或中期随访研究中，狼疮性肾炎（LN）患者的肾移植有令人满意的结果。然而，关于长期结果的信息却很少。我们进行了一项回顾性配对队列研究，将74例LN肾移植受者与148例非LN对照者进行比较，后者在年龄、性别、免疫抑制治疗、人类白细胞抗原（HLA）匹配和移植时期方面进行了匹配，以评估LN肾移植受者肾移植的长期结果。配对组主要为女性（83%），移植手术时的中位年龄为32岁（四分位间距23 - 38岁），66%接受了来自活体亲属供者的移植物。在LN肾移植受者中，5年、10年、15年和20年的移植物存活率分别为81%、79%、57%和51%，与对照组观察到的结果相似（分别为89%、78%、64%和56%）。LN肾移植受者与对照组之间的移植物丢失率（27%对21%，p = 0.24）和总生存率（p = 0.15）没有差异。此外，在免疫排斥、血栓形成或感染发作方面也没有差异。只有6例LN肾移植受者经活检证实有狼疮复发，其中3例出现移植物丢失。在对肾移植受者进行长期随访的队列中，当两组之间的预测因素相匹配时，LN肾移植受者与非狼疮受者相比，具有相似的长期移植物存活率和总体结果。
