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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
Published on: June 8, 2022
Renal transplantation in lupus nephritis
1IRCCS Instituto Auxologicio, Milan, Italy. croff1@policlinico.mi.it
Insights
Kidney transplantation is a viable option for most systemic lupus erythematosus (SLE) patients. Careful pre-transplant screening for cardiovascular issues and antiphospholipid antibodies is crucial for successful renal transplant outcomes in SLE.
Area of Science:
- Nephrology
- Immunology
- Cardiology
Background:
- Systemic lupus erythematosus (SLE) patients often have comorbidities impacting transplant success.
- Cardiovascular disease is a major concern in SLE, affecting morbidity and mortality.
- Recurrence of lupus nephritis post-transplant is a possibility.
Purpose of the Study:
- To review the suitability and considerations for renal transplantation in SLE patients.
- To highlight pre-transplant screening protocols for SLE patients undergoing kidney transplant.
- To discuss post-transplant management and outcomes in SLE patients.
Main Methods:
- Review of existing literature on renal transplantation in SLE.
- Analysis of pre-transplant risk factors and post-transplant complications.
- Discussion of immunosuppression strategies and graft outcomes.
Main Results:
- Most SLE patients are candidates for renal transplant, but require careful screening.
- Pre-transplant screening for cardiovascular disease and antiphospholipid antibodies is recommended.
- Recurrence of lupus nephritis is infrequent and usually mild, with rare graft failure.
- Steroid-free immunosuppression is preferred post-transplant to minimize toxicity.
Conclusions:
- Renal transplantation can yield good results in carefully selected SLE patients.
- Optimizing patient condition before transplant is key to successful outcomes.
- Adherence to specific selection criteria ensures comparable results to other transplant recipients.
Abstract:
Most patients with systemic lupus erythematosus (SLE) are suitable candidates for renal transplantation. However, a number of them may present some disease-related problems. As cardiovascular disease is a leading cause of morbidity and mortality in SLE patients, a careful pretransplant cardiovascular screening is recommended. A search for antiphospholipid antibodies is also useful as the presence of these antibodies can cause an early graft thrombosis. The risk of recurrence of SLE nephritis after transplantation may range between 2 and 30%. In most cases recurrence is characterized by mild histologic lesions. Only rarely does it lead to graft failure. Postransplant immunosuppression does not differ from that used routinely. Whenever possible, a steroid-free immunosuppression should be scheduled to prevent iatrogenic toxicity in patients who have already received long-term steroid treatment. The results of kidney transplantation largely depend on the clinical conditions at transplantation. In patients with poor clinical status or receiving an aggressive immunosuppression it is advisable to postpone the transplant. When some selection criteria are respected, the results of renal trasplantation in SLE patients are at least as good as in other transplant recipients.
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