title: Renal transplantation in antineutrophil cytoplasmic antibody-associated vasculitis: a multicenter experience.
abstract: BACKGROUND
  Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a common cause of rapidly progressive glomerulonephritis resulting in end-stage renal disease (ESRD). The optimal timing of kidney transplantation (KTX) for ESRD as a result of AAV and the risk of AAV relapse after KTX are not well defined. We report our experience with AAV patients who underwent KTX at our institutions between 1996 and 2010. Median follow-up was 64 months.
  
  
  METHODS
  Retrospective multicenter cohort study.
  
  
  RESULTS
  Eighty-five patients (45 men/40 women; mean age 49 years) received a KTX for ESRD secondary to microscopic polyangiitis (n=43) or Wegener's granulomatosis (n=42). Twenty-four patients underwent preemptive KTX and 69 received a living-donor KTX. All patients were in remission at the time of KTX. Fifty-eight patients received induction therapy. In 64 patients, maintenance immunosuppression was with prednisone, mycophenolate mofetil, and tacrolimus. At the time of KTX, 29 patients were ANCA-positive. The vasculitis relapse rate was 0.02 per patient-years and was not influenced by disease category, ANCA subtype, or remission duration before KTX. There were 23 rejection episodes in 13 patients with seven graft losses. Median serum creatinine at 1 year was 1.3 mg/dL in 75 patients with more than 1 year follow-up and 1.4 mg/dL at last follow-up. The graft and patient survival rates were 100% at 1 year, 97.9% and 93.4% at 5 years, and 79.0% and 67.4% at 10 years, respectively.
  
  
  CONCLUSIONS
  KTX is a safe and an effective option for treating ESRD secondary to AAV. Relapses are rare with current immunosuppression.
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Duvuru
authors.initials: D
authors.lastname: Geetha
authors.forename: Alfonso
authors.initials: A
authors.lastname: Eirin
authors.forename: Karin
authors.initials: K
authors.lastname: True
authors.forename: Maria
authors.initials: M
authors.lastname: Valentina Irazabal
authors.forename: Ulrich
authors.initials: U
authors.lastname: Specks
authors.forename: Philip
authors.initials: P
authors.lastname: Seo
authors.forename: Patrick
authors.initials: P
authors.lastname: Nachman
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Fervenza
mesh_terms: D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood / Q000276:immunology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D012008:Recurrence; D051437:Renal Insufficiency / Q000276:immunology* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014657:Vasculitis / Q000150:complications / Q000276:immunology*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents