RENAL-TRANSPLANTATION FOR PATIENTS WITH AUTOIMMUNE-DISEASES - SINGLE-CENTER EXPERIENCE WITH 42 PATIENTS

Background. In patients with autoimmune diseases such as vasculitis or systemic lupus erythematosus (SLE), end-stage renal disease develops in a high percentage of patients, and kidney transplantation has becom e a therapeutic option, However, only limited data about the prognosis and outcome after kidney transplantation are available. Methods. Long -term graft survival and graft function of renal transplant recipients with SLE, Wegener's granulomatosis, microscopic polyangiitis, Good-pa sture's syndrome, and Henoch-Schonlein purpura were evaluated in a sin gle center, In addition, the incidence of renal and extrarenal relapse s and the impact of the immunosuppressive therapy on the course of the autoimmune disease were studied. Results. Renal transplant recipients with autoimmune diseases such as vasculitis and SLE had a patient sur vival rate (94% after 5 years) and a graft survival rate (65% after 5 years) comparable to those of patients with other causes of end-stage renal disease (patient survival 88% and graft survival 71% after 5 yea rs), Graft losses due to the underlying disease were rare. Extrarenal relapses occurred in three patients with Wegener's granulomatosis, one patient with microscopic polyangiitis, and three patients with SLE, b ut were less frequent compared with the period with chronic dialysis t herapy, Autoantibody levels in patients with SLE, Wegener's granulomat osis, or microscopic polyangiitis did not seem to influence the outcom e. Conclusions. Renal transplantation should be offered to patients wi th autoimmune diseases. Follow-up should include the short-term contro l of renal and extrarenal disease activity.