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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 Sep; 60(9):2757-66.AR

Abstract

OBJECTIVE

To determine the risk factors for recurrent lupus nephritis, allograft loss, and survival among patients with systemic lupus erythematosus (SLE) undergoing kidney transplantation.

METHODS

The archival records of all kidney transplant recipients with a prior diagnosis of SLE (according to the American College of Rheumatology criteria) from June 1977 to June 2007 were reviewed. Patients who had died or lost the allograft within 90 days of engraftment were excluded. Time-to-event data were examined by univariable and multivariable Cox proportional hazards regression analyses.

RESULTS

Two hundred twenty of nearly 7,000 renal transplantations were performed in 202 SLE patients during the 30-year interval. Of the 177 patients who met the criteria for study entry, the majority were women (80%) and African American (65%), the mean age was 35.6 years, and the mean disease duration was 11.2 years. Recurrent lupus nephritis was noted in 20 patients (11%), allograft loss in 69 patients (39%), and death in 36 patients (20%). African American ethnicity was found to be associated with a shorter time-to-event for recurrent lupus nephritis (hazard ratio [HR] 4.63, 95% confidence interval [95% CI] 1.29-16.65) and death (HR 2.47, 95% CI 0.91-6.71), although, with the latter, the association was not statistically significant. Recurrent lupus nephritis and chronic rejection of the kidney transplant were found to be risk factors for allograft loss (HR 2.48, 95% CI 1.09-5.60 and HR 2.72, 95% CI 1.55-4.78, respectively). In patients with recurrent lupus nephritis, the lesion in the engrafted kidney was predominantly mesangial, compared with a predominance of proliferative or membranous lesions in the native kidneys.

CONCLUSION

African American ethnicity was independently associated with recurrent lupus nephritis. Allograft loss was associated with chronic transplant rejection and recurrence of lupus nephritis. Recurrent lupus nephritis is infrequent and relatively benign, without influence on a patient's survival.

Authors+Show Affiliations

University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL 35204, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19714623

Citation

Burgos, Paula I., 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 and Rheumatism, vol. 60, no. 9, 2009, pp. 2757-66.
Burgos PI, Perkins EL, Pons-Estel GJ, 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):2757-66.
Burgos, P. I., Perkins, E. L., Pons-Estel, G. J., Kendrick, S. A., Liu, J. M., Kendrick, W. T., Cook, W. J., Julian, B. A., Alarcón, G. S., & Kew, C. E. (2009). Risk factors and impact of recurrent lupus nephritis in patients with systemic lupus erythematosus undergoing renal transplantation: data from a single US institution. Arthritis and Rheumatism, 60(9), 2757-66. https://doi.org/10.1002/art.24776
Burgos PI, 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):2757-66. PubMed PMID: 19714623.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors and impact of recurrent lupus nephritis in patients with systemic lupus erythematosus undergoing renal transplantation: data from a single US institution. AU - Burgos,Paula I, AU - Perkins,Elizabeth L, AU - Pons-Estel,Guillermo J, AU - Kendrick,Scott A, AU - Liu,Jigna M, AU - Kendrick,William T, AU - Cook,William J, AU - Julian,Bruce A, AU - Alarcón,Graciela S, AU - Kew,Clifton E,2nd PY - 2009/8/29/entrez PY - 2009/8/29/pubmed PY - 2009/10/20/medline SP - 2757 EP - 66 JF - Arthritis and rheumatism JO - Arthritis Rheum. VL - 60 IS - 9 N2 - OBJECTIVE: To determine the risk factors for recurrent lupus nephritis, allograft loss, and survival among patients with systemic lupus erythematosus (SLE) undergoing kidney transplantation. METHODS: The archival records of all kidney transplant recipients with a prior diagnosis of SLE (according to the American College of Rheumatology criteria) from June 1977 to June 2007 were reviewed. Patients who had died or lost the allograft within 90 days of engraftment were excluded. Time-to-event data were examined by univariable and multivariable Cox proportional hazards regression analyses. RESULTS: Two hundred twenty of nearly 7,000 renal transplantations were performed in 202 SLE patients during the 30-year interval. Of the 177 patients who met the criteria for study entry, the majority were women (80%) and African American (65%), the mean age was 35.6 years, and the mean disease duration was 11.2 years. Recurrent lupus nephritis was noted in 20 patients (11%), allograft loss in 69 patients (39%), and death in 36 patients (20%). African American ethnicity was found to be associated with a shorter time-to-event for recurrent lupus nephritis (hazard ratio [HR] 4.63, 95% confidence interval [95% CI] 1.29-16.65) and death (HR 2.47, 95% CI 0.91-6.71), although, with the latter, the association was not statistically significant. Recurrent lupus nephritis and chronic rejection of the kidney transplant were found to be risk factors for allograft loss (HR 2.48, 95% CI 1.09-5.60 and HR 2.72, 95% CI 1.55-4.78, respectively). In patients with recurrent lupus nephritis, the lesion in the engrafted kidney was predominantly mesangial, compared with a predominance of proliferative or membranous lesions in the native kidneys. CONCLUSION: African American ethnicity was independently associated with recurrent lupus nephritis. Allograft loss was associated with chronic transplant rejection and recurrence of lupus nephritis. Recurrent lupus nephritis is infrequent and relatively benign, without influence on a patient's survival. SN - 0004-3591 UR - https://www.unboundmedicine.com/medline/citation/19714623/Risk_factors_and_impact_of_recurrent_lupus_nephritis_in_patients_with_systemic_lupus_erythematosus_undergoing_renal_transplantation:_data_from_a_single_US_institution_ L2 - https://doi.org/10.1002/art.24776 DB - PRIME DP - Unbound Medicine ER -