Martínez-López David, Sánchez-Bilbao Lara, De Cos-Gómez Marina, González-Mazón Iñigo, Rodrigo-Calabia Emilio, Ruiz-San Millán Juan Carlos, Gómez Román Javier, Castañeda Santos, González-Gay Miguel Angel, Hernández Jose Luis, Blanco Ricardo
Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology, and Internal Medicine Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
Nephrology Division, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Clin Exp Rheumatol. 2022 Mar;40(3):581-588. doi: 10.55563/clinexprheumatol/ri873i. Epub 2021 Oct 13.
Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE). Unfortunately, 10-20% of patients with LN develop end-stage renal disease (ESRD), and renal transplantation may be a therapeutic option. However, concerns about LN recurrence after transplant have been reported. We aimed to assess long-term post-transplant graft and patient survival in LN compared to patients with non-autoimmune nephropathy (polycystic kidney disease - PCKD).
We carried out a single-centre retrospective study of all patients who underwent renal transplantation due to LN in a referral unit between 1980 and 2018. This cohort was compared with a group of PCKD patients. The main outcome variables were graft and patient survival for up to 20 years, and the time-course of serum creatinine and proteinuria in the first 5 years after transplantation. Cumulative survival rates were estimated by the Kaplan-Meier method and compared using the log-rank test.
We included 53 patients: LN group (n=21) and PCKD group (n=32). Baseline clinical characteristics were similar in both groups, except age at transplantation (39.8±11.3 years in the LN group and 46.6±5.0 years in the PCKD group; p=0.004). No significant differences were found regarding graft (p=0.59) or patient survival (p=0.087) at 20 years of follow-up.
Despite concerns about LN recurrence after renal transplantation, this study shows that this procedure might be a safe alternative therapy for ESRD related to SLE and may provide long-term survival.
狼疮性肾炎（LN）是系统性红斑狼疮（SLE）的一种严重并发症。不幸的是，10%-20%的LN患者会发展为终末期肾病（ESRD），肾移植可能是一种治疗选择。然而，已有关于移植后LN复发的相关报道。我们旨在评估与非自身免疫性肾病（多囊肾病-PCKD）患者相比，LN患者移植后的长期移植物和患者生存率。
我们对1980年至2018年间在一家转诊单位因LN接受肾移植的所有患者进行了单中心回顾性研究。该队列与一组PCKD患者进行比较。主要结局变量为长达20年的移植物和患者生存率，以及移植后前5年血清肌酐和蛋白尿的时间进程。采用Kaplan-Meier法估计累积生存率，并使用对数秩检验进行比较。
我们纳入了53例患者：LN组（n=21）和PCKD组（n=32）。两组的基线临床特征相似，但移植时的年龄不同（LN组为39.8±11.3岁，PCKD组为46.6±5.0岁；p=0.004）。随访20年时，在移植物（p=0.59）或患者生存率（p=0.087）方面未发现显著差异。
尽管担心肾移植后LN复发，但本研究表明，该手术可能是与SLE相关的ESRD的一种安全替代疗法，并可能提供长期生存。
