Romero Karam Lily A, Patel Amol M, Truong Luan, Gonzalez Juan M
Department of Medicine, Houston Methodist Hospital, Houston, Texas.
Department of Medicine, Houston Methodist Hospital, Houston, Texas.
Transplant Proc. 2020 Mar;52(2):614-618. doi: 10.1016/j.transproceed.2019.10.034. Epub 2020 Feb 10.
Renal transplantation is an ever-growing therapeutic option for patients with end-stage renal disease due to lupus nephritis. Outcomes for these patients are comparable to those of patients receiving renal transplantation for other causes. A known complication for these patients is recurrence of lupus nephritis in the renal graft (recurrent lupus nephritis [RLN]). Although disease severity at the time of recurrence is usually milder, a small number of cases have been reported to progress to allograft failure. There is a trend toward preemptive renal transplantation in patients with lupus nephritis, as more favorable outcomes have been observed with this treatment modality. While clinicians usually seek clinical remission of lupus prior to proceeding with renal transplantation, no guidelines are established regarding how often to check for serologic activity of lupus in patients with end-stage renal disease due to lupus nephritis and whether these serologic markers should be taken into account when deciding on the timing of transplantation. We present a case of early RLN co-occurring with acute cellular rejection 15 days after renal transplantation. The patient had been in clinical remission for more than 5 months prior to transplantation but had a rise in anti-double-stranded DNA antibody titers and a decrease in complement C3 level at the time of surgery. Although additional studies are needed to establish the extent to which serologic markers of lupus correlate with renal graft dysfunction, this case suggests hypocomplementemia and high double-stranded DNA antibody titers may be a risk factor for early RLN.
对于狼疮性肾炎所致终末期肾病患者而言，肾移植是一种日益常用的治疗选择。这些患者的治疗效果与因其他病因接受肾移植的患者相当。这些患者已知的一种并发症是肾移植中狼疮性肾炎复发（复发性狼疮性肾炎[RLN]）。尽管复发时疾病严重程度通常较轻，但据报道仍有少数病例进展为移植肾失功。狼疮性肾炎患者有进行抢先肾移植的趋势，因为已观察到这种治疗方式有更良好的效果。虽然临床医生通常会在进行肾移植前寻求狼疮的临床缓解，但对于狼疮性肾炎所致终末期肾病患者应多久检查一次狼疮的血清学活性，以及在决定移植时机时是否应考虑这些血清学标志物，尚无相关指南。我们报告一例肾移植后15天发生早期RLN并伴有急性细胞排斥反应的病例。该患者在移植前临床缓解已超过5个月，但手术时抗双链DNA抗体滴度升高且补体C3水平降低。尽管需要更多研究来确定狼疮的血清学标志物与移植肾功能障碍的关联程度，但该病例提示低补体血症和高双链DNA抗体滴度可能是早期RLN的一个危险因素。
