589
Goral S,
Ynares C, Shappell SB, Snyder SB. Foqo A, Helderman JH, Johnson KH. Vanderbilt
University Medical Center, Nashville, Tennessee
Although
recurrent lupus nephritis (RLN) is said to be rare, recent anecdotes
suggest a higher incidence. In order to determine accurately the incidence
of RLN in renal allografts, we retrospectively reviewed the records of 45
patients with end-stage renal disease due to systemic lupus erythematosus
transplanted between 1976 and 1996. Twenty-four patients (53%) were
biopsied because of worsening renal function and proteinuria, generally to
rule out rejection. One patient had inadequate biopsy sample RLN was
present in 11 patients (46% of patients biopsied, 24 4% of total
patients); 3 male and 8 female, mean age of 37 _ 9 (range 23-56). All but
two of 18 biopsies in these 11 patients had concomitant rejection (acute
in 6, chronic in 6 and mixed in 4). Five patients had mesangial lupus
nephritis (LN) (WHO class II) at 7 to 125 months after transplantation.
Three patients had focal proliferative LN (WHO class Ill) at 5 weeks, 6
weeks and 6 months posttransplant, one of whom showed worsened LN at
repeat biopsy 51 months later. Three patients had membranous LN (WHO class
V) at 31 _ 6 months posttransplant. Patients received treatment for
concomitant rejection, except for one without evidence of rejection who
was treated for RLN One patient had graft loss due to recurrent LN at 10.5
years. In the group of patients without recurrence of LN (2 male and 10
female, mean age of 30 _ 8 (range 20-46)) diagnoses included acute
rejection, chronic rejection, acute tubular necrosis, thrombotic
microangiopathy and arterial thrombosis. The duration of dialysis prior to
transplant was longer in patients who experienced RLN (49 _ 45 months vs
25 _ 30 months). We conclude that although RLN is much more common than
previously thought, it rarely leads to graft loss.