Renal transplantation in patients with microscopic polyarteritis and antimyeloperoxidase antibodies: report of three cases.
This paper reports on 3 patients on renal dialysis for crescentic glomerulonephritis associated with microscopic polyarteritis (MPA) and antineutrophil cytoplasmic autoantibodies specific for myeloperoxidase (MPO-ANCAs). They successfully underwent renal transplantation from a cadaver donor 6-63 months after the onset of the disease, despite the persistence of antibodies at high titer. A triple immunosuppressive regimen including steroids, cyclosporin and azathioprine was used. One patient underwent transplantectomy for surgical complications 3 months later, while the serum creatinine was 2.0 mg/dl (178 mu mol/l): the remainder have a well-functioning graft after 21 and 38 months, no clinical sign of disease recurrence, and a MPO titer within the normal range. We conclude that MPA patients can undergo renal transplantation even if ANCAs persist at a high titer in the circulation.
Frasca
G M
GM
Institute of Nephrology, St. Orsola University Hospital, Bologna, Italy.
Neri
L
L
Martello
M
M
Sestigiani
E
E
Borgnino
L C
LC
Bonomini
V
V
D000293:Adolescent; D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D003404:Creatinine / Q000097:blood; D005260:Female; D005921:Glomerulonephritis / Q000209:etiology / Q000276:immunology / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology; D016030:Kidney Transplantation; D008297:Male; D009195:Peroxidase / Q000276:immunology*; D010488:Polyarteritis Nodosa / Q000150:complications / Q000276:immunology / Q000601:surgery*; D006435:Renal Dialysis
D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D003404:Creatinine; D009195:Peroxidase