Results and prognosis of kidney transplantation in lupus nephritis: Experience of an Argentine center.

INTRODUCTION: Although RT has improved the survival of the population with ESRD due to all causes, renal outcomes in SLE are controversial. The objective of this study is to describe the characteristics and evolution of the patients and the kidney transplant in LN, and compare it with patients transplanted for other causes. MATERIALS AND METHODS: Retrospective, observational, analytical, single-center study in which records of patients undergoing nephrotransplantation for LN were analyzed. They were compared with a group of patients transplanted at the same center for other causes of ESRD. RESULTS: 41 patients with kidney transplant due to SLE and 89 transplanted due to other causes of ESRD were registered. Graft loss occurred in 12 (29.26%) patients with LN and 34 (38.2%) patients in the comparison group (p = .428). Only one case (4.8%) presented reactivation of the LN in the graft, without graft loss. Median graft survival was 73.1 months in the LN group and 66.3 months in the comparison group (p = .221). A total of 8 (19.5%) patients with LN and 11 (12.4%) without LN died (p = .42), with infections being the main cause in both groups. There were no statistically significant differences between groups in graft and patient survival. In a sub-analysis of 28 patients with LN with aPL study, 4 thrombotic events were observed, in 3 different patients, in the aPL-positive group. There were no statistically significant differences in terms of causes of graft loss and graft survival (positive aFL 75.7 months vs negative aFL 72.7 months, p= .96). There were also no differences in mortality between the groups (p = .61). CONCLUSION: Patients transplanted for LN did not differ from the control population in terms of graft and patient survival. Infections were the main cause of death, so prophylaxis and vaccination continue to be a fundamental pillar in the prevention of infections in immunocompromised patients.

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America.

OBJECTIVE: We assessed patient and graft outcomes and prognostic factors in kidney transplantation in patients with end-stage kidney disease (ESKD) secondary to lupus nephritis (LN) undergoing kidney transplantation from August 1977 to December 2014 in a Latin American single center. METHODS: The primary endpoint was patient survival, and the secondary endpoints were death-censored graft survival for the first renal transplant and the rate of recurrent LN (RLN). Kaplan-Meier method was used for survival analysis. Factors predicting patient and death-censored graft survivals were examined by Cox proportional-hazards regression analyses. RESULTS: 185 patients were retrospectively evaluated. Patient survival rates were 88% at one year, 82% at three years, 78% at five years, and 67% at ten years. Death-censored graft survival for the first renal transplant was 93% at one year, 89% at three years, 87% at five years, and 80% at ten years. RLN was diagnosed in 2 patients (1.08%), but no graft was lost because of RLN. Thirty-nine (21.1%) patients died, and 65 (35.1%) patients experienced graft loss during the follow-up. By multivariable analyses, older recipient age and 1-month posttransplantation eGFR <45 ml/min/1.73m2 were associated with lower patient survival and an increased risk of graft loss, while induction immunosuppressive therapy exerted a protective effect on patients' survival. In the subgroup of patients in whom disease activity was measured at the time of transplantation, a higher SLEDAI score was also associated with lower patient survival and an increased risk of graft loss. CONCLUSION: In a mostly Mestizo population, kidney transplantation is an excellent therapeutic alternative in LN patients with ESKD. Older recipient age, an eGFR <45 ml/min/1.73m2 at one month posttransplantation, and disease activity at the time of transplantation are predictive of a lower patient and death-censored graft survival, while induction immunosuppressive therapy has a protective effect on patient survival. RLN is rare and does not influence the risk of graft loss.

Outcome and Prognosis of Patients With Lupus Nephritis Submitted to Renal Transplantation.

This stydy aimed to evaluate the epidemiological and clinical profile and outcome of patients with lupus nephritis (LN) submitted to renal transplantation. Retrospective cohort study based on the records of 35 LN patients submitted to renal transplantation at a single center in Brazil between July 1996 and May 2016. The Kaplan-Meier method was used to estimate 6-month, 1-year and 5-year graft survival. The sample included 38 transplantations (3 of which retransplantations). The mean age at the time of SLE diagnosis was 23.7 ± 9.0 years. Most patients were female (94.7%) and 68.4% were non-Caucasian. Twenty-two (57.9%) underwent renal biopsy prior to transplantation. The mean time from SLE diagnosis to transplantation was 10.3 ± 6.4 years. The mean pre-transplantation dialysis time was 3.8 ± 3.7 years. The grafts came from living related (n = 11) or deceased (n = 27) donors. Three (7.9%) patients experienced acute rejection in the first year. Graft and patient survival rates were, respectively, 97.1% and 100% at 6 months, 84.9% and 96.9% at 1 year, and 76.3% and 92.5% at 5 years. One (2.6%) patient had SLE recurrence. Venous thrombosis (p = 0.017) and antiphospholipid syndrome (APS) (p = 0.036) were more prevalent in patients with graft loss. In our cohort of LN patients submitted to renal transplantation, the 5-year survival rate was high, and APS was an important predictor of poor renal outcome (graft loss).

Early outcomes in kidney transplant recipients with systemic lupus erythematosus.

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.

Kidney transplantation for end-stage renal disease in lupus nephritis, a very safe procedure: a single Latin American transplant center experience.

Background Lupus nephritis (LN) is one of the most frequent complications of SLE and occurs in up to 50% of cases depending on the studied population. Of these, approximately 20% progress to end-stage renal disease (ESRD), with the treatment of choice being a kidney transplant. Objective The objective of this study was to describe the clinical outcome of patients transplanted due to LN, compared with patients transplanted for other causes, in a Latin American population from the Fundación Valle del Lili in Cali, Colombia. Methods Observational, retrospective case study with controls matched by age, sex and type of donor in a single center between 1996 and 2014. Results Sixty-five kidney transplants were performed in patients with LN and ESRD. The survival of patients with LN was 98% at 1, 10 and 15 years ( p = .99). For controls by age and sex, survival was also 98% at 15 years post-transplant, and for controls by donor, the survival rate was 100% at 5 years and 98% at 15 years. Graft survival in patients with LN to 1, 5 and 15 years was 92%, 83% and 71%, respectively; for controls by age and sex, it was 90%, 84% and 64%, respectively, and for the controls by donor, it was 89%, 86% and 79%, respectively ( p = .7718). There were no statistically significant differences found in the cumulative incidence of acute graft rejection in the first year, but it was found that acute rejection is a factor that relates to the loss of function of the renal graft ( p = .032). Of the patients transplanted for LN, two (3.1%) experienced a recurrence of the disease. One patient died after a diagnosis of recurrence of LN due to an infection. Conclusions Kidney transplantation is a good option for patients with ESRD due to LN. In this Hispanic population, the survival of patients, graft survival, and cumulative incidence of graft rejection are not different from those of other transplanted patients. In addition, recurrence of LN was rare, showing the benefits of renal transplantation in LN patients with ESRD.

Outcomes in renal transplant recipients with lupus nephritis: experience at a single center.

BACKGROUND: The long-term prognosis of renal transplant recipients with systemic lupus erythematosus is still controversial. The outcome of these patients depends on the population studied, race/ethnicity, socioeconomic conditions, donor-related factors and recurrent lupus nephritis (LN), among other factors. OBJECTIVE: This study was conducted to evaluate kidney transplantation outcomes for adult Brazilian patients with LN at a single center. SUBJECTS AND METHOD: The archival records of all patients with LN who had received a kidney transplant at Santa Casa of Sao Paulo Hospítal were reviewed. Kaplan-Meier method was used to determine the survival rate. RESULTS: We identified 18 patients with LN subjected to 22 kidney transplants during the 20-year interval. Two patients received three renal grafts. The majority of the patients were female, with 33.7 ± 10 years at the time of the transplantation, and half of them were African descendants or mixed. Sixteen transplants were performed from deceased donors and six from living-related donors. The patient survival rate was 90%, and graft survival was 68% at 10 years. Chronic allograft nephropathy was the major cause of graft loss. Two patients developed extra-renal manifestations of lupus. There was no clinical or histological evidence of recurrent LN. CONCLUSION: Renal transplantation is a method which can provide a long-term survival for patients with SLE and end-stage renal disease.

Renal transplantation in lupus nephritis: a Brazilian cohort.

OBJECTIVE: To determine the epidemiological profile and outcome of patients with lupus nephritis (LN) undergoing renal transplantation. METHODS: The archival records of 50 patients with LN and end-stage renal disease (ESRD) treated by kidney transplantation from March 1992 to December 2010 were reviewed. All patients met the American College of Rheumatology criteria for systemic lupus erythematosus (SLE). RESULTS: Fourteen patients were included in the study. The majority were women (85.7%) and non-Caucasian (85.7%); the mean age at diagnosis of SLE and LN was 24 ± 8 and 25 ± 8 years, respectively. Renal biopsy was performed in 12 patients, with 75% of them showing proliferative lesions (class III and IV according to the World Health Organization and International Society of Nephrology/Renal Pathology Society classification). Thirteen patients (93%) underwent intermittent hemodialysis or peritoneal dialysis before transplantation. The median time between the start of dialysis and transplantation was 30 months (range 3-103 months); 67% of the procedures involved deceased donors and 33% involved living-related donors. The graft survival rates were 93.3%, 90.9%, and 85.7% at 1, 5 and 10 years, respectively. Post-transplant immunosuppressive agents were mycophenolate mofetil (84%), azathioprine (17%), tacrolimus (25%), sirolimus (58%) and cyclosporine (8%). Eight episodes of acute rejection were noted in six patients. There was a graft loss due to renal vein thrombosis in the one patient with secondary antiphospholipid syndrome. The mean SLICC by the time of kidney transplantation was 5 ± 2. In total, 13 patients (92.8%) developed at least one infectious event during the follow-up, with one dying in the immediate post-transplant period because of sepsis. Two patients (14%) had a lupus flare. There was no clinical or histological evidence of LN recurrence. CONCLUSION: LN is the major cause of morbidity in SLE, with progression to ESRD in 10-22% of cases. Despite concerns about LN recurrence after renal transplantation, the data obtained in our sample indicate this procedure as a safe alternative therapy for ESRD in this population.

[Necrotizing pneumonia by community-acquired, methicillin-resistant Staphylococcus aureus in Colombia]. / Neumonía necrosante por Staphylococcus aureus extrahospitalario resistente a la meticilina: reporte de dos casos en Colombia.

The emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) as a cause of severe infections has been described in the recent years. In 2006, the first report of skin and soft tissue infection by CA-MRSA was published in Colombia. Herein, two additional cases of CA-MRSA are reported with a clinical course characterized by rapid progression, prolonged stay in the intensive care unit and complication of pneumonia with the onset of empyema. Both adult patients developed acute renal failure, and were treated with linezolide; the subsequent clinical response showed adequate treatment response. Molecular characterization of the isolates indicated the presence of the mecA gene carrying the cassette SCCmec type IV and the production of the toxin panton-valentine leukocidin.

Detection of amastigotes of Trypanosoma cruzi in a kidney graft with acute dysfunction.

We described a case of allograft kidney dysfunction associated with renal parenchymal infection with amastigotes of Trypanosoma cruzi. The patient was diagnosed as being chronically infected prior to transplantation. The infection was probably acquired by blood transfusion. He could not complete antiparasitic treatment due to drug toxicity. He was transplanted from a cadaver who showed a negative test for Chagas' disease. One year after transplantation the serum creatinine progressively increased. Histological examination of renal biopsy revealed intracytoplasmic amastigotes of T cruzi. No evidence of other specific alterations in the graft was detected. It was unknown whether graft dysfunction was only due to parasitic infection. The present case confirmed that T cruzi can infect kidney grafts and that immunosuppression in kidney transplantation is potentially a cause of dissemination of Chagas' disease.

Transplante renal em pacientes com lúpus eritematoso disseminado

Na Unidade de Transplante Renal do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, 12 pacientes portadores de lúpus eritematoso disseminado foram submetidos a 14 transplantes renais no período de 1975 a 1985. Onze pacientes eram do sexo feminino. O transplante foi realizado, em média, aos 28 anos, após cerca de nove anos de doença. A sobrevida atuarial dos pacientes foi de 81%, do 1§ ao 4§ ano, e do enxerto, 64%, 59% e 59% no 1§, 2§ e 4§ ano de seguimento. Três pacientes perderam os rins e retornaram para a diálise. Três pacientes faleceram, dois precocemente e um após seis anos do transplante. Dois rins foram perdidos por rejeiçäo hiperaguda. Uma paciente teve atividade sistêmica da doença caracterizada por plaquetopenia e hipocomplementemia, sem comprometimento renal, e outra teve recidiva da nefropatia no 5§ mês pós-transplante, evoluindo para uremia após quatro anos e meio. Conclui-se, após análise da casuística e revisäo da literatura, que o transplante renal é a terapêutica de escolha para o paciente lúpico em uremia