OUTCOME OF RENAL-TRANSPLANTATION IN 97 CYCLOSPORINE-ERA PATIENTS WITHSYSTEMIC LUPUS-ERYTHEMATOSUS AND MATCHED CONTROLS

Objective. To evaluate the effectiveness of renal transplantation in s ystemic lupus erythematosus (SLE). Methods. A total of 97 SLE patients who underwent renal transplantation between January 1984 and Septembe r 1996 were selected for study and were matched with a group of non-SL E controls (1 control for each SLE patient) who also received transpla nts during that period. SLE patients and controls were matched on 6 co variates: age, sex, race, type of allograft (cadaveric versus living-r elated), number of previous transplants, and year of transplantation. An study subjects received either cyclosporine or FK-506/tacrolimus as part of their immunosuppressive regimen. In a rigorous medical record s review the status of each allograft and the cause of each graft loss was determined. Using a stratified Cox proportional hazards model, th e transplantation outcomes of the SLE patients were compared with thos e of the controls. The effects of 9 individual variables ore transplan tation outcomes mere also examined, and the statistically significant variables were compared in a stratified, multivariate Cox proportional hazards model, Results. The control group included patients with 20 d ifferent causes of end-stage renal disease (ESRD), The mean followup t imes for the SLE patients and controls were 323 weeks and 320 weeks, r espectively. During the follow-up period, 52 SLE patients and 37 contr ols lost their allografts, The 1-, 2-, 5-, and 10-year allograft survi val probabilities for the 2 groups (SLE versus controls) were as follo ws: 81.7% versus 88.2% (1-year); 74.7% versus 54.4% (2-year); 45.9% ve rsus 75.0% (5-year); and 18.5% versus 34.8% (11-year). In the multivar iate model, the relative hazard of allograft loss associated with SLE as the cause of ESRD was 2.1 (95% confidence interval 1.06-4.06, P = 0 .0328). The total number of HLA mismatches, smoking status, and delaye d allograft function were also associated with allograft loss in the m ultivariate model. Conclusion, Compared with matched controls, renal t ransplant patients with SLE had inferior transplantation outcomes, wit h more than twice the risk of allograft loss.