Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Int J Rheum Dis. 2024 Sep;27(9):e15349. doi: 10.1111/1756-185X.15349.
Clinical manifestations and risk factors associated with systemic lupus erythematosus (SLE) flares, including recurrent lupus nephritis (LN), in patients with LN who undergo kidney transplantation have been unclear.
Kidney transplant recipients with LN from January 1995 to December 2021 were included in this study. A disease flare was defined as either an increase in the non-renal SLE disease activity index score or the presence of biopsy-proven recurrent LN.
Among a total of 93 patients with LN who underwent kidney transplantation, 11 patients (11.8%) experienced SLE flares during a median follow-up period of 76.9 months (IQR, 43.0-122.4). The most common clinical manifestations of SLE flares were recurrent LN (4/11, 36.4%) and hematologic manifestations (4/11, 36.4%). Patients who had flares had significantly higher anti-double-stranded DNA (anti-dsDNA) antibody titers both before and after transplantation. Furthermore, an increased anti-dsDNA antibody level before transplantation was associated with a high risk of an SLE flare (HR, 1.030; p = .008). Conversely, preemptive transplantation was associated with a lower risk of a flare (HR, 0.617; p = .026). The rate of patient death-censored graft survival was found to be considerably lower in patients with recurrent LN than in those without LN.
Approximately 10% of patients with LN experienced an SLE flare after transplantation, with recurrent LN being the most frequent manifestation. Anti-dsDNA antibody titers before transplantation were significantly related to the risk of an SLE flare. Notably, preemptive transplantation was associated with a reduced risk of flares following transplantation.
狼疮肾炎（LN）患者接受肾移植后，其系统性红斑狼疮（SLE）发作的临床表现和相关风险因素（包括复发性狼疮肾炎[LN]）仍不明确。
本研究纳入了 1995 年 1 月至 2021 年 12 月期间接受肾移植的 LN 患者。疾病发作定义为非肾脏 SLE 疾病活动指数评分增加或活检证实复发性 LN。
在总共 93 例接受肾移植的 LN 患者中，11 例（11.8%）在中位随访 76.9 个月（IQR，43.0-122.4）期间发生了 SLE 发作。SLE 发作的最常见临床表现是复发性 LN（4/11，36.4%）和血液学表现（4/11，36.4%）。有发作的患者在移植前后的抗双链 DNA（抗 dsDNA）抗体滴度均显著升高。此外，移植前抗 dsDNA 抗体水平升高与 SLE 发作风险增加相关（HR，1.030；p=0.008）。相反，抢先移植与发作风险降低相关（HR，0.617；p=0.026）。与无 LN 患者相比，复发性 LN 患者的患者死亡-移植物存活率明显较低。
LN 患者在移植后约有 10%发生 SLE 发作，最常见的表现为复发性 LN。移植前的抗 dsDNA 抗体滴度与 SLE 发作风险显著相关。值得注意的是，抢先移植与移植后发作风险降低有关。
