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Renal transplantation in children with lupus nephritis
Debbie S Gipson1, Maria E Ferris, Mary Anne Dooley
1Divisions of Nephrology and Hypertension and Rheumatology, University of North Carolina-Chapel Hill, NC, USA. debbie_gipson@med.unc.edu
Background:
This study was conducted to determine renal allograft and patient survival for children with lupus nephritis compared with pediatric allograft recipients with other causes of end-stage renal disease.
Methods:
Data from the United Network for Organ Sharing registry for children aged 1 to 21 years who received an initial renal transplant between 1987 and 1997 were included. Subjects with kidney failure caused by other vasculitides were excluded, as were those with multiple organ transplants.
Results:
A total of 7,926 children (n = 254 children with lupus) were available for evaluation. Patients with lupus were older (median age, 19 versus 15 years; P < 0.01) and more commonly female (80% versus 40%; P < 0.01) and black (34% versus 20%; P < 0.01) than patients without lupus. Median follow-up was 4.2 years (range, 0.03 to 13 years). Renal allograft survival was not different between groups when adjusting for sex, race, age, and cadaveric (CAD) transplant (P = 0.98). Among patients with lupus, those with CAD allografts were 1.9 times (95% confidence interval [CI], 1.1 to 3.3; P = 0.02) more likely to lose their graft than those with living donor grafts. This increased risk for graft failure with CAD transplants was observed to a lesser degree in subjects without lupus (hazard ratio, 1.3; 95% CI, 1.2 to 1.5). Patients with lupus were 1.8 times more likely to die compared with patients without lupus in multivariate analysis (95% CI, 1.14 to 2.74; P = 0.01).
Conclusion:
Although allograft survival is not different, patient survival after renal transplantation is less for pediatric patients with lupus compared with other pediatric renal allograft recipients.