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

.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 DOI: https://doi.org/10.1002/art.24776

.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 DOI: https://doi.org/10.1191/0961203302lu158oa

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 DOI: https://doi.org/10.3904/kjim.2011.26.1.60

Mojcik CF, Klippel JH. End-stage renal disease and systemic lupus erythematosus. Am J Med. 1996;101:100–107 DOI: https://doi.org/10.1016/S0002-9343(96)00074-5

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 DOI: https://doi.org/10.1016/j.transproceed.2013.11.080

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 DOI: https://doi.org/10.1097/TP.0b013e318292520e

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 DOI: https://doi.org/10.7705/biomedica.v23i3.1223

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 DOI: https://doi.org/10.1016/S0025-6196(12)65589-X

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 DOI: https://doi.org/10.1177/0961203311430220

Ponticelli C, Moroni G. Renal transplantation in lupus nephritis. Lupus. 2005;14(1):95–98 DOI: https://doi.org/10.1191/0961203305lu2067oa

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 DOI: https://doi.org/10.1007/s10067-011-1931-y

Ghafari A, Etemadi J, Ardalan MR. Renal transplantation in patients with lupus nephritis: a single-center experience. Transplant Proc. 2008;40(1):143–144 DOI: https://doi.org/10.1016/j.transproceed.2007.12.013

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 DOI: https://doi.org/10.1097/00007890-198811000-00015

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 DOI: https://doi.org/10.1016/j.transproceed.2005.02.062

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 DOI: https://doi.org/10.1111/j.1399-0012.2004.00297.x

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 DOI: https://doi.org/10.1681/ASN.2009101093

Ponticelli C, Moroni G, Glassock RJ. Recurrence of secondary glomerular disease after renal transplantation. Clin J Am Soc Nephrol. 2011;6(5):1214–1221 DOI: https://doi.org/10.2215/CJN.09381010

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 DOI: https://doi.org/10.1093/ndt/gfh657

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 DOI: https://doi.org/10.1253/circj.CJ-10-1235

Berthoux F, Mariat C. Cardiovascular death after renal transplantation remains the first cause despite significant quantitative and qualitative changes. Transplantation. 2010;89(7):806 DOI: https://doi.org/10.1097/TP.0b013e3181caeece

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 DOI: https://doi.org/10.1111/j.1600-6143.2007.02101.x

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 DOI: https://doi.org/10.1016/j.transproceed.2012.11.013

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 DOI: https://doi.org/10.1111/j.1432-2277.2011.01237.x

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 DOI: https://doi.org/10.1016/j.transproceed.2008.10.034

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 DOI: https://doi.org/10.1093/ndt/11.supp6.24

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 DOI: https://doi.org/10.1016/S0272-6386(12)80523-3

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 DOI: https://doi.org/10.1093/ndt/13.11.2894

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 DOI: https://doi.org/10.1016/j.transproceed.2012.07.063

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 DOI: https://doi.org/10.1002/1529-0131(199808)41:8<1438::AID-ART14>3.0.CO;2-A

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 DOI: https://doi.org/10.1016/S0049-0172(97)80033-9

Stone JH. End-stage renal disease in lupus: disease activity, dialysis, and the outcome of transplantation. Lupus. 1998;7(9):654–659 DOI: https://doi.org/10.1191/096120398678920811

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 DOI: https://doi.org/10.1081/JDI-200056606

O'Toole SM, Fan SL, Yaqoob MM, Chowdhury TA. Managing diabetes in dialysis patients. Postgrad Med J. 2012;88(1037):160–166 DOI: https://doi.org/10.1136/postgradmedj-2011-130354

Cameron JS. Lupus nephritis. J Am Soc Nephrol JASN. 1999;10(2):413–424 DOI: https://doi.org/10.1681/ASN.V102413

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 DOI: https://doi.org/10.1097/00007890-200109150-00047

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 DOI: https://doi.org/10.1053/j.ajkd.2005.01.038

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 DOI: https://doi.org/10.1111/j.1432-2277.2003.tb00322.x

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 DOI: https://doi.org/10.1177/0961203313513819

Ward M. Outcomes of renal transplantation among patients with end-stage renal disease caused by lupus nephritis. Kidney Int. 2000;57(5):2136–2143 DOI: https://doi.org/10.1046/j.1523-1755.2000.00065.x

Massy Z, Ma J, Louis T, Kasiske B. Lipid-lowering therapy in patients with renal disease. Kidney Int. 1995;48(1):188–198 DOI: https://doi.org/10.1038/ki.1995.284

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

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

Downloads

Download data is not yet available.