title: Renal transplantation in lupus nephritis: a Brazilian cohort.
abstract: OBJECTIVE
  To determine the epidemiological profile and outcome of patients with lupus nephritis (LN) undergoing renal transplantation.
  
  
  METHODS
  The archival records of 50 patients with LN and end-stage renal disease (ESRD) treated by kidney transplantation from March 1992 to December 2010 were reviewed. All patients met the American College of Rheumatology criteria for systemic lupus erythematosus (SLE).
  
  
  RESULTS
  Fourteen patients were included in the study. The majority were women (85.7%) and non-Caucasian (85.7%); the mean age at diagnosis of SLE and LN was 24 ± 8 and 25 ± 8 years, respectively. Renal biopsy was performed in 12 patients, with 75% of them showing proliferative lesions (class III and IV according to the World Health Organization and International Society of Nephrology/Renal Pathology Society classification). Thirteen patients (93%) underwent intermittent hemodialysis or peritoneal dialysis before transplantation. The median time between the start of dialysis and transplantation was 30 months (range 3-103 months); 67% of the procedures involved deceased donors and 33% involved living-related donors. The graft survival rates were 93.3%, 90.9%, and 85.7% at 1, 5 and 10 years, respectively. Post-transplant immunosuppressive agents were mycophenolate mofetil (84%), azathioprine (17%), tacrolimus (25%), sirolimus (58%) and cyclosporine (8%). Eight episodes of acute rejection were noted in six patients. There was a graft loss due to renal vein thrombosis in the one patient with secondary antiphospholipid syndrome. The mean SLICC by the time of kidney transplantation was 5 ± 2. In total, 13 patients (92.8%) developed at least one infectious event during the follow-up, with one dying in the immediate post-transplant period because of sepsis. Two patients (14%) had a lupus flare. There was no clinical or histological evidence of LN recurrence.
  
  
  CONCLUSIONS
  LN is the major cause of morbidity in SLE, with progression to ESRD in 10-22% of cases. Despite concerns about LN recurrence after renal transplantation, the data obtained in our sample indicate this procedure as a safe alternative therapy for ESRD in this population.
authors: Disciplina de Reumatologia, Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors: C S
authors: CS
authors: Oliveira
authors: I
authors: I
authors: d Oliveira
authors: A B S
authors: AB
authors: Bacchiega
authors: E M
authors: EM
authors: Klumb
authors: E M M
authors: EM
authors: Albuquerque
authors: E
authors: E
authors: Souza
authors: J H S
authors: JH
authors: Suassuna
authors: F M
authors: FM
authors: Ribeiro
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008181:Lupus Nephritis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D010530:Peritoneal Dialysis / Q000379:methods; D012008:Recurrence; D006435:Renal Dialysis / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents