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Silva RM, Leal R, Marques MG, Rodrigues L, Santos L, Romãozinho C, Alves R, Figueiredo A. Renal Transplantation in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Single-Center 10-Year Experience. Transplant Proc 2023; 55:1396-1399. [PMID: 37202303 DOI: 10.1016/j.transproceed.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a common cause of rapidly progressive glomerulonephritis resulting in end-stage renal disease. The optimal timing of kidney transplantation for end-stage renal disease due to AAV and the risk of relapse after kidney are poorly defined. Our study aimed to evaluate the clinical outcomes of AAV after kidney transplantation, namely the risk of relapse, rejection, and oncologic disease. METHODS This retrospective study included all patients with AAV submitted to a kidney transplant between January 2011 and December 2020. RESULTS Twenty-seven patients (20 males/7 females; mean age 47 years) received a kidney transplant for end-stage renal disease secondary to microscopic polyangiitis (n = 25) or granulomatosis with polyangiitis (n = 2). All patients were in clinical remission at the time of the kidney transplant, but 11 patients were ANCA-positive. A vasculitis relapse after kidney transplantation occurred in only 1 patient (3.7%). Rejection episodes, proven by allograft biopsy, were present in 3 patients (11.1%), with graft losses in 2 (66.7%). The median time until the graft was lost after the initial rejection diagnosis was 27 ± 8 months. Oncologic complications were present in 9 patients (33.3%). Five patients died (18.5%), and the main cause of death was cardiovascular disease (n = 3, 60.0%), followed by oncologic disease (n = 2, 40.0%). CONCLUSIONS Kidney transplantation is a safe and effective option for treating end-stage renal disease secondary to AAV. Current immunosuppression regimens make relapses and rejection infrequent but place oncologic complications at a higher incidence.
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Affiliation(s)
- Rita M Silva
- Department of Nephrology, Urology, and Kidney Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.
| | - Rita Leal
- Department of Nephrology, Urology, and Kidney Transplantation, Coimbra University Hospital Center, Coimbra, Portugal; Nephrology University Clinic, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria G Marques
- Department of Nephrology, Urology, and Kidney Transplantation, Coimbra University Hospital Center, Coimbra, Portugal; Nephrology University Clinic, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Luís Rodrigues
- Department of Nephrology, Urology, and Kidney Transplantation, Coimbra University Hospital Center, Coimbra, Portugal; Nephrology University Clinic, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lídia Santos
- Department of Nephrology, Urology, and Kidney Transplantation, Coimbra University Hospital Center, Coimbra, Portugal; Nephrology University Clinic, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Catarina Romãozinho
- Department of Nephrology, Urology, and Kidney Transplantation, Coimbra University Hospital Center, Coimbra, Portugal; Nephrology University Clinic, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Rui Alves
- Department of Nephrology, Urology, and Kidney Transplantation, Coimbra University Hospital Center, Coimbra, Portugal; Nephrology University Clinic, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Arnaldo Figueiredo
- Department of Nephrology, Urology, and Kidney Transplantation, Coimbra University Hospital Center, Coimbra, Portugal; Urology University Clinic, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Silva RM, Leal R, Marques MG, Rodrigues L, Santos L, Romaozinho C, Alves R, Figueiredo A. Treatment of Recurrent Antineutrophil Cytoplasmic Antibody-Associated Vasculitis After Kidney Transplant With Rituximab: A Successful Case Report. EXP CLIN TRANSPLANT 2023; 21:171-174. [PMID: 36919725 DOI: 10.6002/ect.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Antineutrophil cytoplasm antibody-associated systemic vasculitis is a rare disease that frequently leads to end-stage renal disease. Kidney transplant should be delayed until patients are in complete clinical remission for at least 6 months, but the persistence of antineutrophil cytoplasmic antibody titers should not delay transplant. Recurrence of disease after kidney transplant is rare, with only a few cases described in the literature with heterogenous clinical manifestations, therapeutic approaches, and prognosis. We describe the case of a young male patient with recurrent antineutrophil cytoplasmic antibody vasculitis, 5 years after kidney transplant, successfully treated with methylprednisolone pulses plus rituximab. Rituximab presents a new valid option for the treatment of antineutrophil cytoplasmic antibody vasculitis relapse in kidney grafts.
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Affiliation(s)
- Rita M Silva
- From the Department of Nephrology, Urology, and Kidney Transplantation, Coimbra University Hospital Center, Portugal
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Cody E, Hooper DK. Kidney transplantation in pediatric patients with rheumatologic disorders. Curr Opin Pediatr 2022; 34:234-240. [PMID: 34954727 DOI: 10.1097/mop.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Providers caring for children with end-stage kidney disease from rheumatologic conditions face questions such as when to proceed with kidney transplantation, how common is disease recurrence posttransplant, how does recurrent disease impact patient and allograft outcomes, and what approaches are available to prevent and treat recurrent disease. We discuss recent developments and relevant literature that address these questions for the most common rheumatologic disorders that lead to end-stage kidney disease in childhood namely, systemic lupus erythematosus, IgA nephropathy, IgA Vasculitis/Henoch Schoenlein Purpura, and Anti-Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis. RECENT FINDINGS Recent data suggest that children with IgA nephropathy, IgA vasculitis, and ANCA-associated vasculitis have similar patient and allograft survival to other conditions despite the risk of recurrent disease, yet those with lupus have worse posttransplant patient and allograft outcomes. A period of disease quiescence may be prudent prior to transplantation to decrease the risk of recurrence, which is associated with decreased allograft survival. Data on preventive strategies and treatment options are limited. SUMMARY It is recommended that patients with systemic rheumatologic conditions not be excluded from kidney transplantation but that patients be counseled on the risk of potential recurrent disease with its impact on transplant outcomes.
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Affiliation(s)
- Ellen Cody
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center
| | - David K Hooper
- Division of Nephrology and Hypertension, Department of Pediatrics, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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