The outcome of kidney transplantation in lupus patients

Kidney transplantation represents a therapeutic option for individuals with end-stage renal disease due to lupus. However, the influence of lupus activity and immunosuppressive medications on graft survival remains a matter of concern and it has not been thoroughly elucidated.

In this study, we conducted a retrospective review of 45 lupus patients who underwent kidney transplantation, with the aim of analyzing graft survival and identifying factors influencing the outcome of kidney transplantation in lupus patients.

Graft survival rates at 1, 5, 10, 15, and 20 years were 98%, 98%, 88%, 85%, and 78%, respectively. Univariate logistic regression revealed hypertension, positive panel reactive antibodies against HLA class II antigens, retransplant, young age at lupus nephritis onset, low postoperative C4 levels, and HBsAg and/or anti-HBe antibody presence were significantly correlated with decreased graft survival (p < 0.05). Multiple regression confirmed the significant association of HBsAg and/or anti-HBe antibody with graft failure (p = 0.0161), with all patients testing negative for anti-HBc antibody. Preoperative markers (C3, C4, anti-dsDNA antibody) and recurrent lupus nephritis did not impact graft failure.

In lupus patients undergoing kidney transplantation, hepatitis B serology emerges as a potential singular predictor for graft failure, while preoperative lupus activity markers and recurrent lupus nephritis do not affect outcomes.