LONG-TERM OUTCOME AND EVOLUTION OF DISEASE ACTIVITY IN SYSTEMIC LUPUS ERYTHEMATOSUS IN CHINESE PATIENTS AFTER RENAL TRANSPLANTATION

Background: The long-term outcome of renal transplantations caused by lupus nephritis and the issue of relapse of disease are still matters of controversy. Some studies reported inferior graft survival in patients with than without systemic lupus erythematous (SLE). The paper is to determine the long-term outcome of renal transplantation in end stage renal disease caused by lupus nephritis and the systemic lupus erythematous disease activity in different stages by the measurement of serial activity index change. Material and Methods: Renal transplantation patients with an underlying disease of lupus nephritis and followed up at our hospital were recruited for retrospective analysis. A group of age and sex-matched non-lupus renal transplant patients served as control, Most of the patients were immunosupressed with triple therapy including corticosteroid, calcineurin inhibitor and antimetabolite. Lupus activity was evaluated periodically with serological tests. Patient and graft survival were calculated and compared. Results: A total of 20 lupus patients undergoing renal transplantation were enrolled. The demographic data were not different significantly between the 2 groups. The mean duration of follow-up was 109.2±69.4 months. The overall patient and graft survival rates were 94.4% and 66.1% at 10 years posttransplant which were not significantly different than the control group (90.1% and 62.8%, respectively) Recurrence of lupus nephritis in renal allograft was not found in our study. Five grafts losses occurred in the SLE group .One patient expired one year after transplantation doe to pneumonia with septic shock. The others are alive until now. The lupus activity quenched when patient became ESRD and clinically represented burn-out appearance. Acute rejection rate throughout whole course of allograft in the SLE group is 36.8%. Complications of lupus transplant group were infection (45%) and avascular necrosis of femoral neck or knee (15%). Conclusions: Patients with end stage renal disease caused by lupus nephritis are suitable candidates for renal transplantation. The patient and graft survival rate is comparable to that of ESRD caused by other diseases. Flare-up of lupus activity was not observed in this study.