Premature Cardiovascular Disease in Patients With Systemic Lupus Erythematosus Influences Survival After Renal Transplantation
Premature Cardiovascular Disease in Patients With Systemic Lupus Erythematosus Influences Survival After Renal Transplantation
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DOI：
10.1002/art.30184
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发表时间：
2011-03-01
影响因子：
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通讯作者：
Holdaas, Hallvard
中科院分区：
文献类型：
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作者：
Norby, Gudrun E.;Leivestad, Torbjorn;Holdaas, Hallvard
Objective.评估系统性红斑狼疮（SLE）患者肾移植后移植物和患者的存活率以及移植物丢失和患者死亡的原因。从1972年至2005年，对77例SLE患者进行了87次肾移植。每例SLE受者与2例非SLE肾小球肾炎肾移植受者匹配（移植日期、年龄、供体来源[存活与死亡]和性别），比较SLE组和非SLE组的移植物存活率和患者存活率。SLE患者移植时的平均+/- SD年龄为37.4 +/- 12.8岁，大多数SLE患者为女性（80.5%）。SLE患者与对照移植患者在移植日期、年龄和供体来源（活体与已故供体）方面匹配良好。接受移植的SLE患者的死亡删失移植物存活率与对照组密切相关; SLE患者的1年、5年和10年移植物存活率分别为88%、81%和71%，非SLE肾小球肾炎患者分别为91%、83%和74%（P = 0.31）。患者生存率差异显著; SLE受者1年、5年和10年的生存率分别为94%、83%和71%。在非SLE肾小球肾炎队列中，相应的患者生存率分别为96%、92%和85%（P = 0.018）。心血管事件是SLE患者最主要的死亡原因（66.7%，对照组39.5%; P = 0.03）。SLE移植患者的移植物存活率与非SLE肾小球肾炎受者相当。接受移植的SLE患者的存活率低于对照组患者。SLE的死亡率过高是由于心血管死亡人数较多。
Objective. To assess graft and patient survival as well as causes for graft loss and patient death after renal transplantation in patients with systemic lupus erythematosus (SLE).Methods. Eighty-seven renal transplantations were performed in 77 patients with SLE from 1972 to 2005. Each recipient with SLE was matched (for date of transplant, age, donor source [living versus deceased], and sex) with 2 renal graft recipients who had non-SLE glomerulonephritis, and the SLE and non-SLE groups were compared with regard to graft survival and patient survival.Results. The mean +/- SD age of SLE patients at the time of transplantation was 37.4 +/- 12.8 years, and the majority of SLE patients were female (80.5%). SLE patients were well matched to control transplant patients for date of transplant, age, and donor source (living versus deceased donor). The death-censored graft survival rate for SLE patients receiving transplants corresponded closely to that for the control groups; the 1-, 5-, and 10-year graft survival rates were 88%, 81%, and 71%, respectively, for SLE patients, and 91%, 83%, and 74%, respectively, for patients with non-SLE glomerulonephritis (P = 0.31). Patient survival differed significantly; the rates of survival for recipients with SLE were 94%, 83%, and 71% at 1, 5, and 10 years, respectively. The corresponding rates of patient survival in the non-SLE glomerulonephritis cohort were 96%, 92%, and 85% (P = 0.018). Cardiovascular events were the most prominent cause of death in SLE patients (66.7%, versus 39.5% in the control group; P = 0.03).Conclusion. Transplant patients with SLE have a graft survival rate that matches that of recipients with non-SLE glomerulonephritis. SLE patients who receive transplants have a lower survival rate than control patients. The excessive mortality in SLE is attributed to a greater number of cardiovascular deaths.