SYSTEMIC VASCULITIS IN A KIDNEY-TRANSPLANT POPULATION

Background. Systemic vasculitis as original disease might adversely in fluence the result of kidney transplantation. Methods. The clinical co urse after 32 transplantations to 26 patients with microscopic polyang iitis, Wegener's granulomatosis, Henoch-Schonlein purpura, thrombotic thrombocytopenic purpura/hemolytic uremic syndrome, or Goodpasture's d isease was evaluated, The median follow-up time was 82 months (range, 4-132 months), Frozen sera from 25 transplantations were analyzed for Goodpasture antibodies, myeloperoxidase antineutrophil cytoplasmic ant ibodies (ANCA), and proteinase 3 ANCA. Results. Survival of patients a nd grafts did not differ between patients and matched controls, Recurr ent vasculitis occurred with seven grafts (four patients with microsco pic polyangiitis or Wegener's granulomatosis, two patients with Henoch -Schonlein purpura, and one patient thrombotic thrombocytopenic purpur a), New-onset hematuria was the initial renal symptom in five patients , Treatment with corticosteroids, cyclophosphamide, and/or plasma exch ange was most often effective, but two grafts were lost, Proteinase 3 ANCA titers were increased to 12-738 U/ml before seven transplants, Th e patient with the lowest titer lost his graft due to recurrence, two other patients had reversible recurrence after 1 year and 5 years, two patients lost their grafts due to unknown/unrelated causes, and two p atients' grafts remain without recurrence, Myeloperoxidase ANCA were i ncreased to 22-39 U/ml before two transplants, which have been unevent ful for 4 years. Conclusions. An awareness of the small but perpetual risk of recurrence facilitates early treatment that may save the trans plant, Testing for hematuria and early transplant biopsies, and possib ly monitoring of ANCA titers, are essential, but pretransplant ANCA ti ters have no predictive value in asymptomatic patients, Results of kid ney transplantation in patients with vasculitis are as good as in othe r patients.