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CLINICAL EPIDEMIOLOGY
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Recurrence of Lupus Nephritis after Kidney Transplantation

Gabriel Contreras, Adela Mattiazzi, Giselle Guerra, Luis M. Ortega, Elaine C. Tozman, Hua Li, Leonardo Tamariz, Cristiane Carvalho, Warren Kupin, Marco Ladino, Baudouin LeClercq, Isabel Jaraba, Decio Carvalho, Efrain Carles and David Roth
JASN July 2010, 21 (7) 1200-1207; DOI: https://doi.org/10.1681/ASN.2009101093
Gabriel Contreras
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Adela Mattiazzi
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Giselle Guerra
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Luis M. Ortega
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Elaine C. Tozman
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Hua Li
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Leonardo Tamariz
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Cristiane Carvalho
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Warren Kupin
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Marco Ladino
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Baudouin LeClercq
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Isabel Jaraba
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Decio Carvalho
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Efrain Carles
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David Roth
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Abstract

The frequency and outcome of recurrent lupus nephritis (RLN) among recipients of a kidney allograft vary among single-center reports. From the United Network for Organ Sharing files, we estimated the period prevalence and predictors of RLN in recipients who received a transplant between 1987 and 2006 and assessed the effects of RLN on allograft failure and recipients' survival. Among 6850 recipients of a kidney allograft with systemic lupus erythematosus, 167 recipients had RLN, 1770 experienced rejection, and 4913 control subjects did not experience rejection. The period prevalence of RLN was 2.44%. Non-Hispanic black race, female gender, and age <33 years each independently increased the odds of RLN. Graft failure occurred in 156 (93%) of those with RLN, 1517 (86%) of those with rejection, and 923 (19%) of control subjects without rejection. Although recipients with RLN had a fourfold greater risk for graft failure compared with control subjects without rejection, only 7% of graft failure episodes were attributable to RLN compared and 43% to rejection. During follow-up, 867 (13%) recipients died: 27 (16%) in the RLN group, 313 (18%) in the rejection group, and 527 (11%) in the control group. In summary, severe RLN is uncommon in recipients of a kidney allograft, but black recipients, female recipient, and younger recipients are at increased risk. Although RLN significantly increases the risk for graft failure, it contributes far less than rejection to its overall incidence; therefore, these findings should not keep patients with lupus from seeking a kidney transplant.

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  • Copyright © 2010 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 21 (7)
Journal of the American Society of Nephrology
Vol. 21, Issue 7
1 Jul 2010
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Recurrence of Lupus Nephritis after Kidney Transplantation
Gabriel Contreras, Adela Mattiazzi, Giselle Guerra, Luis M. Ortega, Elaine C. Tozman, Hua Li, Leonardo Tamariz, Cristiane Carvalho, Warren Kupin, Marco Ladino, Baudouin LeClercq, Isabel Jaraba, Decio Carvalho, Efrain Carles, David Roth
JASN Jul 2010, 21 (7) 1200-1207; DOI: 10.1681/ASN.2009101093

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Recurrence of Lupus Nephritis after Kidney Transplantation
Gabriel Contreras, Adela Mattiazzi, Giselle Guerra, Luis M. Ortega, Elaine C. Tozman, Hua Li, Leonardo Tamariz, Cristiane Carvalho, Warren Kupin, Marco Ladino, Baudouin LeClercq, Isabel Jaraba, Decio Carvalho, Efrain Carles, David Roth
JASN Jul 2010, 21 (7) 1200-1207; DOI: 10.1681/ASN.2009101093
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More in this TOC Section

  • The Association of Excess Body Weight with Risk of ESKD Is Mediated Through Insulin Resistance, Hypertension, and Hyperuricemia
  • Association of Clonal Hematopoiesis of Indeterminate Potential with Worse Kidney Function and Anemia in Two Cohorts of Patients with Advanced Chronic Kidney Disease
  • Longitudinal TNFR1 and TNFR2 and Kidney Outcomes: Results from AASK and VA NEPHRON-D
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Cited By...

  • Belatacept in kidney transplant patients with systemic lupus erythematosus
  • Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis
  • Graft Loss Due to Recurrent Lupus Nephritis in Living-Related Kidney Donation
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