title: Renal transplantation in systemic vasculitis: when is it safe?
abstract: BACKGROUND
  There are no clear guidelines on renal transplantation in patients with antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis.
  
  
  METHODS
  We undertook a survey of transplant centres across Europe to assess whether there was consensus about how to manage transplantation in patients with vasculitis. We then identified 107 renal allograft recipients whose primary disease was systemic vasculitis and assessed their outcome post-transplant.
  
  
  RESULTS
  All questionnaire respondents felt that vasculitis should be in remission at transplantation, 16% believed that ANCA should be negative pre-transplant and 40% felt that one should wait >12 months after remission before transplanting. Remission was defined by all as an absence of clinical symptoms of vasculitis, but three respondents (13%) also required a negative ANCA test. Overall graft survival was 70% after 10 years (95% C.I. 58-82). A total of 30 (41% of those with known ANCA status) were ANCA-positive peri-transplantation, while 15 (14%) were transplanted <1 year post-remission. Severe vasculopathy occurred more frequently in ANCA-positive recipients (odds ratio 4.4, 95% C.I. 1.1-16.8, P < 0.05), although causation cannot be determined from this study. Vasculopathy significantly reduced 10-year graft survival to 47% (P < 0.05). However, ANCA status per se was not significantly associated with graft failure. The strongest predictor of death was transplantation <1 year post-vasculitis remission on both univariate and multivariate analysis (hazard ratio 2.3, P < 0.05).
  
  
  CONCLUSIONS
  In conclusion, circulating ANCA at transplant was associated with the development of vascular lesions in the graft but was not significantly correlated with graft survival. Most grafts were lost due to patient death, which was more likely if transplantation occurred <12 months following induction of remission of ANCA-positive vasculitis.
authors: Renal Institute of Birmingham, School of Immunity, Infection and Inflammation, University of Birmingham, Birmingham, UK.
authors: Mark A
authors: MA
authors: Little
authors: Basma
authors: B
authors: Hassan
authors: Steve
authors: S
authors: Jacques
authors: David
authors: D
authors: Game
authors: Emma
authors: E
authors: Salisbury
authors: Aisling E
authors: AE
authors: Courtney
authors: Catherine
authors: C
authors: Brown
authors: Alan D
authors: AD
authors: Salama
authors: Lorraine
authors: L
authors: Harper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications* / Q000276:immunology; D000075202:Contraindications; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult