title: Renal transplantation in anti-neutrophil cytoplasmic antibody-associated vasculitis.
abstract: Despite major advances in the management of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) achieved in the last decades, a large proportion of AAV patients still develop end-stage renal disease. The survival of AAV patients dependent on dialysis is significantly worse compared with dialysis-independent AAV patients, but is comparable to other non-diabetic patients requiring dialysis. Renal transplantation (RTx) is the method of choice among renal replacement therapies and there has been increasing evidence that it is a suitable method with favorable patient- and graft-survival also in AAV patients. It is recommended to perform RTx after ≥12 months of remission, and ANCA positivity at the time of RTx is generally not considered a contraindication. Even though the risk of relapse after RTx is relatively low with current post-transplant immunosuppressive regimens, disease recurrence may occur. Besides cyclophosphamide, rituximab might become a therapeutic alternative for post-transplant AAV recurrence in the near future but its efficacy and safety in this setting needs to be confirmed in larger studies.
authors.affiliation: Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Hruskova
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Duvuru
authors.initials: D
authors.lastname: Geetha
authors.affiliation: Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Tesar
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications* / Q000628:therapy; D006085:Graft Survival; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation; D012074:Remission Induction
keywords: ANCA; outcome; relapse; renal transplantation; vasculitis