Recurrent ANCA-associated small vessel vasculitis after transplantation: Apooled analysis

Background. Recurrent antineutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis (ANCA-SVV) after renal transplantation has been de scribed in case series. However, general information regarding the frequenc y, character, and predictors of recurrent disease after transplantation is currently lacking. We considered the rate of relapse, whether a positive AN CA at the time of transplantation predicted relapse, and whether cyclospori ne A prevented recurrent disease. Methods. We performed a pooled analysis of published data, added to the exp erience at the Universities of North Carolina (14 patients) and Lund, Swede n (11 patients). To avoid reporting bias, only case series were included fo r analysis. Subgroup analysis was performed by disease category (Wegener's granulomatosis, microscopic polyangiitis, or necrotizing crescentic glomeru lonephritis) and ANCA staining pattern. Results. ANCA-SVV recurred in 17.3% of all patients (N = 127), in 20% of cy closporine A-treated patients (N = 85), and in 25.6% of patients with circu lating ANCA at the time of transplantation (N = 39). There was no statistic ally significant difference in the relapse rate between patients treated an d those not treated with cyclosporine A (P = 0.45), between those with and without circulating ANCA at the time of transplant (P = 0.75), or between p atients with Wegener's granulomatosis and those with microscopic polyangiit is or necrotizing crescentic glomerulonephritis alone (P = 0.62). Conclusion. There is a substantial relapse rate in the ANCA-SVV population. Therapy with cyclosporine A does not protect against recurrent ANCA-SVV, a nd the presence of a positive ANCA at the time of transplantation does not preclude transplantation. These conclusions must be substantiated with a pr ospective study of renal transplantation in patients with ANCA-SVV so as to optimize their management.