Kidney transplant (KT) is the best treatment for patients who progress to end-stage renal disease. Short-term outcomes in patients with systemic lupus erythematosus (SLE) following KT are not well known. To describe the postoperative outcomes and complications in SLE patients undergoing KT, we conducted a case–control study from 2010 to 2015 including SLE recipients compared to non-SLE controls matched by age and sex. Demographics, comorbidities, donor characteristics, and preoperative tests were retrieved. Main outcomes were 30-day postoperative allograft function, development of infectious or non-infectious complications, and mortality. 68 patients (34 SLE, 34 non-SLE) were included. SLE recipients had median disease duration of 9 years; SLEDAI-2K of 2, and SLICC/ACR damage index of 3; 16 (47%) were taking prednisone (median dose 5 mg daily) before KT. SLE recipients had a lower frequency of diabetes (0 vs. 27%, p = 0.002). No differences were found in the development of any complication (50% SLE vs. 47% non-SLE, p = 1.00); infectious (44% vs. 41%, p = 1.00), or non-infectious (15% vs. 21%, p = 1.00). There were no deaths in either group, and none of the SLE recipients presented lupus disease activity 30 days after the KT. Allograft function determined by serum creatinine, estimated glomerular filtration rate, delayed graft function, and allograft loss was similar in both groups (p > 0.05). There were no differences between SLE recipients with and without complications. Early postoperative outcomes in SLE patients who undergo KT, including allograft function, development of infectious, non-infectious complications, and mortality, are similar to patients without SLE.
Allografts Delayed graft function Kidney transplantation Lupus nephritis Postoperative complications
This is a preview of subscription content, log in to check access.
No acknowledgements to report.
JMLM, LQG and AHA designed the study; JMLM and LQG participated in acquisition of data: AHA and JCRS analyzed and interpreted data; JMLM, LQG, AHA and JCRS drafted the manuscript; JMLM, LQG, AHA and JCRS revised the manuscript.
The authors declare that this work was not supported by any grant or funding.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Tektonidou MG, Dasgupta A, Ward MM (2016) Risk of end-stage renal disease in patients with lupus nephritis, 1971–2015: a systematic review and bayesian meta-analysis. Arthritis Rheumatol 68:1432–1441CrossRefGoogle Scholar
Marinaki S, Lionaki S, Boletis JN (2013) Glomerular disease recurrence in the renal allograft: a hurdle but not a barrier for successful kidney transplantation. Transpl Proc 45:3–9CrossRefGoogle Scholar
Barnes B, Bergan J, Braun W et al (1975) Renal transplantation in congenital and metabolic disease. A report from the ASC/NIH renal transplant registry. J Am Med Assoc 232:148–153CrossRefGoogle Scholar
Burgos P, Perkins E, Pons-Estel G et al (2009) Risk factors and impact of recurrent lupus nephritis in transplanted patients with systemic lupus erythematosus: data from a single US institution. Arthritis Rheumatol 60:2757–2766CrossRefGoogle Scholar
Contreras G, Mattiazzi A, Guerra G et al (2010) Recurrence of lupus nephritis after kidney transplantation. J Am Soc Nephrol 21:1200–1207CrossRefGoogle Scholar
Kasiske BL, Ramos EL, Gaston RS et al (1995) The evaluation of renal transplant candidates: clinical practice guidelines. Patient Care and Education Committee of the American Society of Transplant Physicians. J Am Soc Nephrol 6:1–34PubMedGoogle Scholar
Signori Baracat AL, Ribeiro-Alves MA, Alves-Filho G, Mazzali M (2008) Systemic lupus erythematosus after renal transplantation: is complement a good marker for graft survival? Transpl Proc 40:746–748CrossRefGoogle Scholar
McIntyre JA, Wagenknecht DR. Antiphospholipid antibodies (2001) Risk assessment for solid organ, bone marrow, and tissue transplantation. Rheum Dis Clin North Am 27:611–631CrossRefGoogle Scholar
Norby GE, Strom EH, Midtvedt K et al (2010) Recurrent lupus nephritis after kidney transplantation: a surveillance biopsy study. Ann Rheum Dis 69:1484–1487CrossRefGoogle Scholar
Aygül Çeltİk A, Sen S, Furkan Tamer A et al (2016) Recurrent lupus nephritis after transplantation: clinicopathological evaluation with protocol biopsies. Nephrology (Carlton) 21:601–607CrossRefGoogle Scholar
Kasiske BL, Cangro CB, Hariharan S et al (2001) The evaluation of renal transplant candidates: clinical practice guidelines. Am J Transpl Suppl 2:3–95Google Scholar
Goral S, Ynares C, Shappell SB et al (2003) Recurrent lupus nephritis in renal transplant recipients revisited: it is not rare. Transplantation 75:651–656CrossRefGoogle Scholar
Golebiewska J, Debska-Ślizień A, Bułło-Piontecka B, Rutkowski B (2016) Outcomes in renal transplantation recipients with lupus nephritis—a single-center experience and review of the literature. Transpl Proc 48:1489–1493CrossRefGoogle Scholar
Ramírez-Sandoval JC, Chavez-Chavez H, Wagner M, Vega-Vega O, Morales-Buenrostro LE, Correa-Rotter R (2018) Long-term survival of kidney grafts in lupus nephritis: a Mexican cohort. Lupus 27:1303–1311CrossRefGoogle Scholar
Tan EM, Cohen AS, Fries JF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheumatol 25:1271–1277CrossRefGoogle Scholar
Gladmann DD, Ginzler E, Goldsmith C et al (1996) The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for systemic lupus erythematosus. Arthritis Rheumatol 39:363–369CrossRefGoogle Scholar
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
Levey AS, Stevens LA, Schmid CH et al (2011) A new equation to estimate glomerular filtration rate. Ann Intern Med 155:408Google Scholar
Chelamcharla M, Javaid B, Baird BC, Goldfarb-Rumyantzev AS (2007) The outcome of renal transplantation among systemic lupus erythematosus patients. Nephrol Dial Transpl 22:3623–3630CrossRefGoogle Scholar
Nieto-Ríos JF, Serna-Higuita LM, Builes-Rodriguez SA et al (2016) Clinical outcomes of kidney transplants on patients with end-stage renal disease secondary to lupus nephritis, polycystic kidney disease and diabetic nephropathy. Colomb Med 47:51–58PubMedPubMedCentralGoogle Scholar
Lionaki S, Kapitsinou PP, Kostakis A, Moutsopoulos HM, Boletis JN (2008) Kidney transplantation in lupus patients: a case–control study from a single centre. Lupus 17:670–675CrossRefGoogle Scholar
Wu C, Evans I, Joseph R et al (2005) Comorbid conditions in kidney transplantation: association with graft and patient survival. J Am Soc Nephrol 16:3437–3444CrossRefGoogle Scholar
Oliveira CS, d’Oliveira I, Bacchiega ABS et al (2012) Renal transplantation in lupus nephritis: a Brazilian cohort. Lupus 21:570–574CrossRefGoogle Scholar
Naranjo-Escobar J, Manzi E, Posada JG et al (2017) Kidney transplantation for end-stage renal disease in lupus nephritis, a very safe procedure: a single Latin American transplant center experience. Lupus 26:1157–1165CrossRefGoogle Scholar
Contreras G, González-Suárez M, Isakova T et al (2014) Kidney allograft survival of African American and Caucasian American recipients with lupus. Lupus 23:151–158CrossRefGoogle Scholar
Meier-Kriesche HU, Scornik JC, Susskind B, Rehman S, Schold JD (2009) A lifetime versus a graft life approach redefines the importance of HLA matching in kidney transplant patients. Transplantation 88:23–29CrossRefGoogle Scholar
Yu TM, Wen MC, Li CY et al (2012) Impact of recurrent lupus nephritis on lupus kidney transplantation. Clin Rheumatol 31:705–710CrossRefGoogle Scholar