Evaluating a Living Donor With Rheumatoid Arthritis for a Recipient With End-Stage Renal Disease From Antineutrophil...

Area of Science:

• Nephrology
• Rheumatology
• Transplant Surgery

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting joints and potentially other organs.
• End-stage kidney disease (ESKD) necessitates kidney transplantation for survival.
• Autoimmune conditions like c-ANCA associated vasculitis (AAV) and membranous nephropathy (MN) pose complex challenges in kidney transplantation.

Observation:

• A potential living kidney donor with sero-positive rheumatoid arthritis (RA) was evaluated for her brother-in-law with ESKD due to AAV and MN.
• Limited data exists regarding kidney donation from RA patients, especially to recipients with AAV.
• Multidisciplinary transplant teams face challenges in decision-making for such unique donor-recipient pairs.

Findings:

• A literature review was conducted to assess recipient outcomes after transplantation from RA donors, focusing on AAV recipients.
• The review also evaluated short- and long-term outcomes for living kidney donors with RA.
• Considerations included the management of renal disease in AAV and RA, and maintaining disease remission post-donation.

Implications:

• This research aims to inform transplant committees on the viability of living kidney donation from RA patients.
• It highlights the need for careful evaluation of donor eligibility and recipient prognosis in complex autoimmune cases.
• Findings may guide future protocols for managing kidney donation in patients with chronic inflammatory and autoimmune diseases.