RISK-FACTORS FOR RENAL-ALLOGRAFT LOSS IN PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS

Controversy exists regarding the risk factors for renal allograft loss in patients with systemic lupus erythematosus (SLE). This study is a retrospective evaluation of each of these independent risk factors in 80 renal transplants for ESRD secondary to SLE done at our institution between 1971 and 1994. Our entire non-diabetic cohort of 1,966 renal transplants is used as a comparison group. Our results showed equivale nt graft survival rates between lupus patients and the cohort at 1, 5 and 10 years (P = 0.56). However, an analysis of cyclosporine-era cada ver grafts revealed that the lupus group had poorer 5-year graft survi val than the cohort (41% vs. 71%, P = 0.02). Evaluation of cyclosporin e-era lupus graft survival showed significantly improved outcome in li ving-related lupus recipients over cadaver grafts at five years (89% v s. 41%, P = 0.003). The majority of grafts lost in the lupus cadaver r ecipients were due to chronic rejection. Rejection was increased in lu pus recipients: 69% of lupus patients experienced rejection in the fir st year compared to 58% of controls (P = 0.01). Stratified for age, se x, race and cyclosporine use, this difference remained significant (P = 0.003, relative risk 1.7). Nephrectomy, splenectomy and 3 to 6 month s of pretransplant dialysis did not improve graft survival. A dialysis duration of greater than 25 months predicted worse graft survival (P = 0.01). Among lupus patients, PRA did not correlate with graft outcom e (P = 0.5), and HLA-identical cadaver grafts had improved outcomes co mpared to cadaver grafts. We conclude that acute and chronic rejection are the major risk factors for graft loss in lupus patients. The supe rior outcome of living-related over cadaver grafts in lupus patients s uggests an increased role for living-related grafts. Pretransplant dia lysis, nephrectomy and splenectomy are not indicated.