LONG-TERM OUTCOME OF KIDNEY-TRANSPLANTATION IN PATIENTS WITH SYSTEMICLUPUS-ERYTHEMATOSUS - A MULTICENTER STUDY

Background The outcome of 60 renal transplantations in 53 patients wit h end-stage renal disease (ESRD) because of lupus nephritis was studie d retrospectively and compared with 106 controls matched for age, sex, maximum panel-reactive antibody (PRA) level, and date of transplantat ion. Methods. The patients received their transplants over a 260-month period (21.5 years) between October 1971 and August 1993. The populat ion was predominantly women (90%), and the mean age at the time of the transplantation was 33.2 years (range: 21-54 years). fifty-six transp lants (93%) were from cadaveric donors, and 4 (7%) were from living-re lated donors; 46 patients (86%) had primary allografts, and 7 (14%) re ceived a second allograft The duration of disease before transplantati on was 93.6+/-6.2 months, and the duration of dialysis before transpla ntation was 48+/-6 months. Results, No patient had clinically active s ystemic lupus erythematosus (SLE) at the time of transplantation. The 1-year graft and patient survival rates were 83% and 98%, and the 5-ye ar graft and patient survival rates were 69% and 96%. Actuarial graft and patient survival rates in SLE patients were not significantly diff erent from those of the matched control group. Chronic rejection was t he major risk factor for graft loss. Lupus nephritis recurred in the g raft of one patient 3 months after transplantation, and there were ext rarenal manifestations of SLE: in four others. Conclusions. The presen t study confirms that patients with SLE can receive transplants with e xcellent graft and patient; survival rates and a low rate of clinical recurrent lupus nephritis.