Risk factors and impact of recurrent lupus nephritis in patients with systemic lupus erythematosus undergoing renal transplantation: data from a single US institution.
OBJECTIVE
To determine the risk factors for recurrent lupus nephritis, allograft loss, and survival among patients with systemic lupus erythematosus (SLE) undergoing kidney transplantation.


METHODS
The archival records of all kidney transplant recipients with a prior diagnosis of SLE (according to the American College of Rheumatology criteria) from June 1977 to June 2007 were reviewed. Patients who had died or lost the allograft within 90 days of engraftment were excluded. Time-to-event data were examined by univariable and multivariable Cox proportional hazards regression analyses.


RESULTS
Two hundred twenty of nearly 7,000 renal transplantations were performed in 202 SLE patients during the 30-year interval. Of the 177 patients who met the criteria for study entry, the majority were women (80%) and African American (65%), the mean age was 35.6 years, and the mean disease duration was 11.2 years. Recurrent lupus nephritis was noted in 20 patients (11%), allograft loss in 69 patients (39%), and death in 36 patients (20%). African American ethnicity was found to be associated with a shorter time-to-event for recurrent lupus nephritis (hazard ratio [HR] 4.63, 95% confidence interval [95% CI] 1.29-16.65) and death (HR 2.47, 95% CI 0.91-6.71), although, with the latter, the association was not statistically significant. Recurrent lupus nephritis and chronic rejection of the kidney transplant were found to be risk factors for allograft loss (HR 2.48, 95% CI 1.09-5.60 and HR 2.72, 95% CI 1.55-4.78, respectively). In patients with recurrent lupus nephritis, the lesion in the engrafted kidney was predominantly mesangial, compared with a predominance of proliferative or membranous lesions in the native kidneys.


CONCLUSIONS
African American ethnicity was independently associated with recurrent lupus nephritis. Allograft loss was associated with chronic transplant rejection and recurrence of lupus nephritis. Recurrent lupus nephritis is infrequent and relatively benign, without influence on a patient's survival.
Burgos
Paula I
PI
University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL 35204, USA.
Perkins
Elizabeth L
EL
Pons-Estel
Guillermo J
GJ
Kendrick
Scott A
SA
Liu
Jigna M
JM
Kendrick
William T
WT
Cook
William J
WJ
Julian
Bruce A
BA
Alarcón
Graciela S
GS
Kew
Clifton E
CE
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000208:ethnology; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000208:ethnology; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000401:mortality; D008181:Lupus Nephritis / Q000453:epidemiology* / Q000208:ethnology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D055815:Young Adult