The outcome of renal transplantation among systemic lupus erythematosus patients
The outcome of renal transplantation among systemic lupus erythematosus patients
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DOI：
10.1093/ndt/gfm459
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发表时间：
2007-12-01
影响因子：
6.1
通讯作者：
Goldfarb-Rumyantzev, Alexander S.
中科院分区：
文献类型：
--
作者：
Chelamcharla, Madhukar;Javaid, Basit;Goldfarb-Rumyantzev, Alexander S.
背景系统性红斑狼疮（SLE）患者肾移植的临床结果仍然是一个有争议的话题。大多数以前的报告是基于小型的单中心研究，并不总是精心设计的。我们使用USRDS和UNOS数据库的数据进行了回顾性分析。根据终末期肾病（ESRD）的病因将患者分为5组：糖尿病（DM）、SLE、肾小球肾炎、高血压和其他原因。从1990年至1999年共92844例肾移植患者中，发现2886例终末期肾病患者。本研究的平均随访期为4.7 +/ 2.4年。虽然使用KaplanMeier曲线进行的未校正分析表明，与DM相比，SLE与移植物存活率改善相关，但在多变量分析中，与DM组相比，SLE组的移植物存活率[风险比（HR）1.09，P <0.05]和受体存活率（HR 1.19，P < 0.05）更差。基于供体类型的亚组分析显示，与非SLE死亡供体同种异体移植物受体相比，接受死亡供体同种异体移植物的SLE患者的移植物和受体存活率更低（HR分别为1.14，P = 0.002和HR 1.30，P = 0.001）。在存活的同种异体移植受者中，与非SLE患者相比，同种异体移植物或受体存活率无显著差异。与糖尿病相比，SLE作为肾移植受者终末期肾病的一个原因与移植物和受者生存率较差相关;这种相关性适用于整个人群和已故供体（而非活体供体）移植的受者。与存活的同种异体移植受者相比，死亡的供体同种异体移植受者的结局更差。
Background. Clinical outcome of renal transplantation among systemic lupus erythematosus (SLE) patients remains a topic of controversy. Most of the previous reports were based upon small single-centre studies that were not always well-designed.Methods. We conducted the retrospective analysis using data from USRDS and UNOS databases. Patients were divided into five groups based on the cause of end-stage renal disease (ESRD): diabetes mellitus (DM), SLE, glomerulonephritis, hypertension and other causes. Between 1990 and 1999, 2886 renal transplantation recipients with ESRD due to SLE were identified from a total of 92844 patients.Results. The mean follow-up period of this study was 4.7 +/ 2.4 years. While unadjusted analysis using KaplanMeier curves demonstrated an association between SLE and improved allograft survival compared with DM, in multivariate analysis the SLE group had worse allograft [hazard ratio (HR) 1.09, P < 0.05] and recipient (HR 1.19, P < 0.05) survival compared with the DM group. Subgroup analysis based on the type of donor showed that SLE patients who received deceased donor allograft had worse allograft and recipient survival (HR 1.14, P = 0.002 and HR 1.30, P = 0.001, respectively) compared with non-SLE deceased donor allograft recipients. Among living allograft recipients, there were no significant differences in either allograft or recipient survival compared with non-SLE recipients.Conclusions. SLE as a cause of ESRD in renal transplant recipients is associated with worse allograft and recipient survival compared with DM; this association is true for the entire population and for the recipients of deceased donor (but not living donor) transplant. Deceased donor allograft recipients have worse outcomes compared with living allograft recipients.