Pachi Beatriz Curto, Bialecki Laura Marcon Bischoff, Borba Luísa Rigon, Bischoff Helena Marcon, Garcia Valter Duro, Meinerz Gisele, Keitel Elizete
Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
J Bras Nefrol. 2025 Apr-Jun;47(2):e20240061. doi: 10.1590/2175-8239-JBN-2024-0061en.
Lupus nephritis (LN) affects up to 50% of patients with systemic lupus erythematosus (SLE) and may lead to kidney failure and require kidney transplantation (KT). Results compared to KT from other causes are controversial, and we aimed to assess the clinical course, complications, and survival of LN patients undergoing KT.
Retrospective cohort of 99 KT due to LN from 1977 to 2023 at a single center, divided into two groups according to the immunosuppression period: G1 (before 2009) and G2 (from 2009 onwards). Clinical and demographic characteristics, as well as clinical evolution, were compared.
Patients were predominantly white (65.9%), female (86.9%), in their first KT (83.8%). The median age was 20.0 (11.5-25.0) years at SLE diagnosis, and 30.0 (23.0-40.0) years at KT. Renal graft biopsy was indicated in 46% of patients, with rejection observed in 23%, and LN recurrence in 5%. When assessing the two distinct periods of standard immunosuppression, there was no difference in median glomerular filtration rate and proteinuria at 1 and 5 years, nor in 5-year survival. Throughout follow-up, 37.4% of patients lost their graft, and 13% died with a functioning graft. No graft loss was attributed to LN recurrence.
KT is a successful treatment for LN, with graft survival rates similar to those of transplants from other causes. LN recurrence was not associated with renal graft loss.
狼疮性肾炎（LN）影响多达50%的系统性红斑狼疮（SLE）患者，可能导致肾衰竭并需要肾移植（KT）。与其他病因的肾移植结果相比存在争议，我们旨在评估接受肾移植的LN患者的临床病程、并发症和生存率。
对1977年至2023年在单一中心因LN进行的99例肾移植进行回顾性队列研究，根据免疫抑制期分为两组：G1组（2009年之前）和G2组（2009年及以后）。比较临床和人口统计学特征以及临床演变情况。
患者以白人为主（65.9%），女性（86.9%），首次接受肾移植（83.8%）。SLE诊断时的中位年龄为20.0（11.5 - 25.0）岁，肾移植时为30.0（23.0 - 40.0）岁。46%的患者进行了肾移植活检，其中23%观察到排斥反应，5%观察到LN复发。在评估标准免疫抑制的两个不同时期时，1年和5年时的中位肾小球滤过率和蛋白尿以及5年生存率均无差异。在整个随访过程中，37.4%的患者移植肾失功，13%的患者在移植肾功能良好时死亡。没有移植肾失功归因于LN复发。
肾移植是LN的一种成功治疗方法，移植肾存活率与其他病因的移植相似。LN复发与移植肾失功无关。
