Main Article Content

Authors

Background:

Patients with lupus nephritis could progress to end-stage renal disease (10-22%); hence, kidney transplants should be considered as the treatment of choice for these patients.

Objective:

To evaluate the clinical outcomes after kidney transplants in patients with chronic kidney diseases secondary to lupus nephritis, polycystic kidney disease and diabetes nephropathy at Pablo Tobon Uribe Hospital.

Methods:

A descriptive and retrospective study performed at one kidney transplant center between 2005 and 2013.

Results:

A total of 136 patients, 27 with lupus nephritis (19.9%), 31 with polycystic kidney disease (22.8%) and 78 with diabetes nephropathy (57.4%), were included in the study. The graft survivals after one, three and five years were 96.3%, 82.5% and 82.5% for lupus nephritis; 90%, 86% and 76.5% for polycystic kidney disease and 91.7%, 80.3% and 67.9% for diabetes nephropathy, respectively, with no significant differences (p= 0.488); the rate of lupus nephritis recurrence was 0.94%/person-year. The etiology of lupus vs diabetes vs polycystic disease was not a risk factor for a decreased time of graft survival (Hazard ratio: 1.43; 95% CI: 0.52-3.93).

Conclusion:

Kidney transplant patients with end stage renal disease secondary to lupus nephritis has similar graft and patient survival success rates to patients with other kidney diseases. The complication rate and risk of recurrence for lupus nephritis are low. Kidney transplants should be considered as the treatment of choice for patients with end stage renal disease secondary to lupus nephritis.

 

John Fredy Nieto-Ríos, -Pablo Tobon Uribe Hospital, Medellin, Colombia -University of Antioquia, Medellin, Colombia

-Section Nephrology. Pablo Tobon Uribe Hospital, Medellin, Colombia

-Section of Nephrology, University of Antioquia, Medellin, Colombia

Lina María Serna-Higuita, Hospital Pablo Tobon Uribe, Medellin, Colombia Universidad de Antioquia. Medellin, Colombia

Section Nephrology. Pablo Tobon Uribe Hospital, Medellin, Colombia

Section of Pediatrics and Child Care, University of Antioquia. Medellin, Colombia

Sheila Alexandra Builes-Rodriguez, Universidad Pontificia Bolivariana, Medellin, Colombia

Section of Nephrology, Universidad Pontificia Bolivariana, Medellin, Colombia

Ricardo Cesar Restrepo-Correa, Hospital Pablo Tobon Uribe. Medellin, Colombia

Section of Internal Medicine, Hospital Pablo Tobon Uribe. Medellin, Colombia

Arbey Aristizabal-Alzate, -Hospital Pablo Tobon Uribe, Medellín, Colombia -Universidad de Antioquia, Medellín, Colombia

Section Nephrology. Pablo Tobon Uribe Hospital, Medellin, Colombia

Section of Nephrology, University of Antioquia, Medellin, Colombia

Catalina Ocampo-Kohn, -Hospital Pablo Tobon Uribe, Medellín, Colombia -Universidad de Antioquia, Medellín, Colombia

Section Nephrology. Pablo Tobon Uribe Hospital, Medellin, Colombia

Section of Nephrology, University of Antioquia, Medellin, Colombia

Angelica Serna-Campuzano, Universidad Pontificia Bolivariana, Medellín, Colombia

Section of Nephrology, Universidad Pontificia Bolivariana, Medellin, Colombia

Natalia Cardona-Díaz, Hospital Pablo Tobon Uribe, Medellín, Colombia

Sección Nefrología. Hospital Pablo Tobon Uribe, Medellín, Colombia

Nelson Dario Giraldo-Ramirez, Pablo Tobon Uribe Hospital, Medellin, Colombia

Section Nephrology. Pablo Tobon Uribe Hospital, Medellin, Colombia

Gustavo Adolfo Zuluaga-Valencia, Hospital Pablo Tobon Uribe, Medellín, Colombia Sección de Nefrología, Universidad de Antioquia, Medellín, Colombia

Sección Nefrología. Hospital Pablo Tobon Uribe, Medellín, Colombia

Sección de Nefrología, Universidad de Antioquia, Medellín, Colombia

Nieto-Ríos, J. F., Serna-Higuita, L. M., Builes-Rodriguez, S. A., Restrepo-Correa, R. C., Aristizabal-Alzate, A., Ocampo-Kohn, C., Serna-Campuzano, A., Cardona-Díaz, N., Giraldo-Ramirez, N. D., & Zuluaga-Valencia, G. A. (2016). Clinical outcomes of kidney transplants on patients with end-stage renal disease secondary to lupus nephritis, polycystic kidney disease and diabetic nephropathy. Colombia Medica, 47(1), 51–58. https://doi.org/10.25100/cm.v47i1.2085

.Burgos PI, Perkins EL, Pons-Estel GJ, Kendrick SA, Liu JM, Kendrick WT, et al. Risk factors and impact of recurrent lupus nephritis in patients with systemic lupus erythematosus undergoing renal transplantation: data from a single US institution. Arthritis Rheum. 2009;60(9):2757–2766

.Bastian H, Roseman J, McGwin Gj, Alarcón G, Friedman A, Fessler B, et al. Systemic lupus erythematosus in three ethnic groups. XII. Risk factors for lupus nephritis after diagnosis. Lupus. 2002;11(3):152–160

Kang S-H, Chung B-H, Choi S-R, Lee J-Y, Park H-S, Sun I-O, et al. Comparison of clinical outcomes by different renal replacement therapy in patients with end-stage renal disease secondary to lupus nephritis. Korean J Intern Med. 2011;26(1):60

Mojcik CF, Klippel JH. End-stage renal disease and systemic lupus erythematosus. Am J Med. 1996;101:100–107

Wu M-J, Lo Y-C, Lan J-L, Yu T-M, Shu K-H, Chen D-Y, et al. Outcome of lupus nephritis after entering into end-stage renal disease and comparison between different treatment modalities: a nationwide population-based cohort study in taiwan. Transplant Proc. 2014;46(2):339–341

Nee R, Jindal RM, Little D, Ramsey-Goldman R, Agodoa L, Hurst FP, et al. Racial differences and income disparities are associated with poor outcomes in kidney transplant recipients with lupus nephritis. Transplantation. 2013;95(12):1471–1478

Collins A, Foley R, Chavers B, Gilbertson D, Herzog C, Johansen K, et al. United States renal data system 2011 Annual Data Report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis. 2012;59 suppl 1:A7, e1-420

Anaya JM, Uribe M, Pérez A, Sánchez JF, Pinto LF, Molina JF, et al. Clinical and immunological factors associated with lupus nephritis in patients from northwestern Colombia. Biomédica. 2003;23:293–300

Hellerstedt W, Johnson W, Ascher N, Kjellstrand C, Knutson R, Shapiro F, et al. Survival rates of 2,728 patients with end-stage renal disease. Mayo Clin Proc. 1984;59(1):776–783

Oliveira C, Oliveira I, Bacchiega A, Klum E, Albuquerque E, Souza E, et al. Renal transplantation in lupus nephritis?:: a Brazilian cohort. Lupus. 2012;21:570–574

Ponticelli C, Moroni G. Renal transplantation in lupus nephritis. Lupus. 2005;14(1):95–98

Yu T-M, Wen M-C, Li C-Y, Cheng C-H, Wu M-J, Chen C-H, et al. Impact of recurrent lupus nephritis on lupus kidney transplantation: a 20-year single center experience. Clin Rheumatol. 2012;31(4):705–710

Ghafari A, Etemadi J, Ardalan MR. Renal transplantation in patients with lupus nephritis: a single-center experience. Transplant Proc. 2008;40(1):143–144

Bumgardner G, Mauer S, Payne W, Dunn D, Sutherland D, Fryd D, et al. Single-center 1-15-year results of renal transplantation in patients with systemic lupus erythematosus. Transplantation. 1988;46(5):703–709

Villaverde Verdejo.P Fernández Rivera C.Alonso Hernández A.Garcia Naveiro R.Cao Vilariño M.Tresancos Fernández C , . Evaluation of renal grafts in patients with lupus nephritis as cause of end-stage renal disease. Transplant Proc. 2005;37(3):1426–1427

Dong G, Panaro F, Bogetti D, Sammartino C, Rondelli D, Sankary H, et al. Standard chronic immunosuppression after kidney transplantation for systemic lupus erythematosus eliminates recurrence of disease. Clin Transplant. 2005;19(1):56–60

Contreras G, Mattiazzi A, Guerra G, Ortega LM, Tozman EC, Li H, et al. Recurrence of lupus nephritis after kidney transplantation. J Am Soc Nephrol. 2010;21(7):1200–1207

Ponticelli C, Moroni G, Glassock RJ. Recurrence of secondary glomerular disease after renal transplantation. Clin J Am Soc Nephrol. 2011;6(5):1214–1221

Tsai J-P, Lian J-D, Wu S-W, Hung T-W, Tsai H-C, Chang H-R. Long-term impact of pretransplant and posttransplant diabetes mellitus on kidney transplant outcomes. World J Surg.

;35(12):2818–2825

Schiel R, Heinrich S, Steiner T, Ott U, Stein G. Long-term prognosis of patients after kidney transplantation: a comparison of those with or without diabetes mellitus. Nephrol Dial Transplant. 2005;20(3):611–617

Natsuaki M, Furukawa Y, Morimoto T, Nakagawa Y, Akao M, Ono K, et al. Impact of diabetes on cardiovascular outcomes in hemodialysis patients undergoing coronary revascularization. Circ J. 2011;75(7):1616–1625

Berthoux F, Mariat C. Cardiovascular death after renal transplantation remains the first cause despite significant quantitative and qualitative changes. Transplantation. 2010;89(7):806

Cosio FG, Hickson LJ, Griffin MD, Stegall MD, Kudva Y. Patient survival and cardiovascular risk after kidney transplantation: the challenge of diabetes. Am J Transplant. 2008;8(3):593–599

Rocha A, Malheiro J, Martins LS, Fonseca I, Dias L, Pedroso S, et al. Kidney transplantation in type 2 diabetic patients?:: A matched survival analysis. Transplant Proc. 2013;45(6):2141–2146

Roozbeh J, Razmkon AR, Jalaeian H, Raiss-Jalali GA, Behzadi S, Sagheb MM, et al. Outcome of kidney transplantation in patients with polycystic kidney disease: A single center study. Saudi J Kidney Dis Transpl. 2008;19(1):72–75

Jacquet A, Pallet N, Kessler M, Hourmant M, Garrigue V, Rostaing L, et al. Outcomes of renal transplantation in patients with autosomal dominant polycystic kidney disease: a nationwide longitudinal study. Transpl Int. 2011;24(6):582–587

Sulikowski T, Tejchman K, Zietek Z, Rózanski J, Domanski L, Kaminski M, et al. Experience with autosomal dominant polycystic kidney disease in patients before and after renal transplantation: a 7-year observation. Transplant Proc. 2009;41(1):177–180

Niemczyk M, Niemczyk S, Paczek L. Autosomal dominant polycystic kidney disease and transplantation. Ann Transplant. 2009;14(4):86–90

Pirson Y, Christophe J, Goffin E. Outcome of renal replacement therapy in autosomal dominant polycystic kidney disease. Nephrol Dial Transplant. 1996;11(6):24–28

Fitzpatrick P, Torres V, Charboneau J, Offord K, Holley K, Zincke H. Long-term outcome of renal transplantation in autosomal dominant polycystic kidney disease. Am J Kidney Dis. 1990;15(6):535–543

Azevedo L, Romão J, Malheiros D, Saldanh a L, Ianhez L, Sabbaga E. Renal transplantation in systemic lupus erythematosus. A case control study of 45 patients. Nephrol Dial Transplant. 1998;13(11):2894–2898

Fuentes L, Hernandez D, Ruiz P, Blanca L, Lopez V, Sola E, et al. Survival of lupus Nephritis Patients After Renal Transplantation In Malaga. Transplant Proc. 2012;44(7):2067–2068

Stone JH, Amend WJ, Criswell LA. Outcome of renal transplantation in ninety-seven cyclosporine-era patients with systemic lupus erythematosus and matched controls. Arthritis Rheum. 1998;41(8):1438–1445

Nyberg G, Karlberg I, Svalander C, Hedman L, Blohmé I. Renal transplantation in patients with systemic lupus erythematosus: increased risk of early graft loss. Scand J Urol Nephrol. 1990;24(4):307–313

Ward MM. Outcomes of renal transplantation among patients with end-stage renal disease caused by lupus nephritis. Kidney Int. 2000;57(5):2136–2143

Stone JH, Amend WJ, Criswell LA. Outcome of renal transplantation in systemic lupus erythematosus. Semin Arthritis Rheum. 1997;27(1):17–26

Stone JH. End-stage renal disease in lupus: disease activity, dialysis, and the outcome of transplantation. Lupus. 1998;7(9):654–659

Johnston O, O'Kelly P, Donohue J, Walshe JJ, Little DM, Hickey D, et al. Favorable graft survival in renal transplant recipients with polycystic kidney disease. Ren Fail. 2005;27(3):309–314

O'Toole SM, Fan SL, Yaqoob MM, Chowdhury TA. Managing diabetes in dialysis patients. Postgrad Med J. 2012;88(1037):160–166

Cameron JS. Lupus nephritis. J Am Soc Nephrol JASN. 1999;10(2):413–424

Bartosh SM, Fine RN, Sullivan EK. Outcome after transplantation of young patients with systemic lupus erythematosus: a report of the North American pediatric renal transplant cooperative study. Transplantation. 2001;72(5):973–978

Nyberg G, Blohmé I, Persson H, Olausson M, Svalander C. Recurrence of SLE in transplanted kidneys: a follow-up transplant biopsy study. Nephrol Dial Transplant. 1992;7(11):1116–1123

Moroni G, Tantardini F, Gallelli B, Quaglini S, Banfi G, Poli F, et al. The long-term prognosis of renal transplantation in patients with lupus nephritis. Am J Kidney Dis. 2005;45(5):903–911

Deegens JKJ, Artz MA, Hoitsma AJ, Wetzels JFM. Outcome of renal transplantation in patients with systemic lupus erythematosus. Transpl Int. 2003;16(6):411–418

Contreras G, Li H, Gonzalez-Suarez M, Isakova T, Scialla JJ, Pedraza F, et al. Kidney allograft survival of African American and Caucasian American recipients with lupus. Lupus. 2014;23(2):151–158

Ward M. Outcomes of renal transplantation among patients with end-stage renal disease caused by lupus nephritis. Kidney Int. 2000;57(5):2136–2143

Massy Z, Ma J, Louis T, Kasiske B. Lipid-lowering therapy in patients with renal disease. Kidney Int. 1995;48(1):188–198

Clark W, Jevnikar A. Renal transplantation for end-stage renal disease caused by systemic lupus erythematosus nephritis. Semin Nephrol. 1999;19(1):77–85

Downloads

Download data is not yet available.
Received 2015-09-09
Accepted 2016-02-15
Published 2016-02-19