Renal transplantation in systemic lupus erythematosus: Comparison of graft survival with other causes of end-stage renal disease

Introduction: End-stage renal disease (ESRD) due to lupus nephritis (LN) occurs in 10%-30% of patients. Initially systemic lupus erythematosus (SLE) was a contraindication for kidney transplantation (KT). Today, long-term graft survival remains controversial. Our objective was to compare the survival after KT in patients with SLE or other causes of ESRD. Methods: All SLE patients who had undergone KT in a retrospective cohort were included. Renal graft survival was compared with that of 50 controls, matched for age, sex, and year of transplantation. Survival was evaluated by the Kaplan-Meier test and the Cox proportional hazards model. Results: Twenty-five subjects with SLE were included. The estimated 1-year, 2- and 5-year survival rates for patients with SLE were 92%, 66% and 66%. Renal graft survival did not differ between patients with SLE and other causes of ESRD (P=.39). The multivariate analysis showed no significant difference in graft survival between the two groups (hazard ratio, HR= 1.95, 95% confidence interval [CI] 0.57-6.61, P= .28). The recurrence rate of LN was 8% and was not associated with graft loss. Acute rejection was the only variable associated with graft loss in patients with SLE (HR= 16.5, 95% CI 1.94-140.1,P= .01). Conclusions: Renal graft survival in SLE patients did not differ from that reported for other causes of ESRD. (C) 2017 Elsevier Espana, S.L.U. and Sociedad Espanola de Reumatologla y Colegio Mexicano de Reumatologia. All rights reserved.