Seminars in arthritis and rheumatism 2016 Sep 21
The utility of lupus serology in predicting outcomes of renal transplantation in lupus patients: Systematic literature review and analysis of the Toronto lupus cohort.
Abstract
Objectives
To study the utility of lupus serology as a predictor for kidney graft outcome in (a) a systematic literature review (SLR) and (b) the Toronto lupus cohort (TLC).
Methods
For the SLR, a comprehensive literature search was performed to identify the articles reporting on the serology at renal transplantation (RT) and on the outcome of RT. Studies were critically appraised using the Newcastle Ottawa Scale (NOS). Patients who underwent RT in the TLC were identified and grouped into graft failure and graft survival. The serology in both groups was studied.
Results
Of the 749 references, 742 did not have serological status of the patient or were not relevant to the research question. Seven studies in addition to TLC (n = 76) were included in the SLR. The NOS revealed limitations because of small sample size and a short follow-up period. The majority of the grafts survived to at least 1 year regardless of the serology results pre-transplant which is consistent with results of the TLC. Overall, 32 of 1783 patients in the TLC had a RT. In all, 2 patients had a nonfunctional graft, 5 patients had graft failure, and 25 patients had graft survival. Overall, 40% of the graft failures had positive serology compared to 52% in the graft survival, 1 year prior to RT.
Conclusion
The results of this SLR found that the persistence of serological abnormalities at the time of RT was not associated with graft failure. These results are consistent with the results of the TLC.
Related Questions
Would you proceed with renal transplant in a patient with lupus nephritis who has progressed to ESRD and is clinically stable, but has persistently elevated dsDNA and low complements despite appropriate doses of hydroxychloroquine and mycophenolate?
Short answer: Yes—if the patient’s clinical lupus is quiescent for at least 6 months, it is reasonable to proceed with kidney transplantation even in the presence of persistent serologic activity (e.g., low complement, elevated anti-dsDNA).Why this matters: Transplant > Dialysis: Patients with LN-ES...
How do you approach “clearing” a patient with SLE and ESRD for renal transplant?
Prefer the term "optimizing" as opposed to "clearing" SLE patients for procedures such as renal transplants and issues here similar to identifying the preferred time to proceed with pregnancy, specifically in patients with a history of LN, with the goal in both scenarios of achieving desired outcome...