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Systemic Lupus Erythematosus after Renal Transplantation: Patient and Graft Survival and Disease Activity

Hans C. Nossent, MD; Tom J. G. Swaak, MD, PhD; Jo H. M. Berden, MD, PhD, Dutch Working Party on Systemic Lupus Erythematosus*
[+] Article, Author, and Disclosure Information

Grant Support: By the Dutch League Against Rheumatism.

Requests for Reprints: Tom J.G. Swaak, MD, PhD, Dr. Daniel den Hoed Clinic, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands.

Current Author Addresses: Dr. Nossent: St. Elisabeth Hospital, Breedestraat Willemstad, Curaçao, Netherlands Antilles.

Dr. Swaak: Dr. Daniel den Hoed Clinic, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands.

Dr. Berden: University Hospital, P.O. Box 9101, Nijmegen, The Netherlands.

From the Dr. Daniel den Hoed Clinic, Rotterdam, The Netherlands; and the University Hospital, Nijmegen, The Netherlands. For current author addresses, see end of text.*The members of the Dutch Working Party on Systemic Lupus Erythematosus were F. Breedveld, R. Derksen, M. Fieren, C. de Glas-Vos, C. Halma, R. Hene, F. van Hoogen, C. Kallenberg, L. Kater, P. de Leeuw, P. van der Merwe, J. van der Meulen, H. Out, P. Schellekens, and R. Smeenk.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(3):183-188. doi:10.7326/0003-4819-114-3-183
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Objective: To determine the outcome of renal transplantation in patients with systemic lupus erythematosus and end-stage renal failure and to compare disease activity after transplantation with disease activity before transplantation.

Design: Retrospective case finding using data for an 8-year period from the central registry for renal replacement therapy in The Netherlands.

Setting: Tertiary care hospitals with facilities for renal transplantation in The Netherlands.

Patients: Twenty-eight patients who fulfilled at least four of the American Rheumatology Association's criteria for the classification of systemic lupus erythematosus and who received a renal transplant.

Measurements: Actuarial survival rates for grafts and patients after transplantation, maximal nonrenal scores on the Systemic Lupus Erythematosus Disease Activity Index, and time-adjusted disease exacerbation rates in all patients before and after transplantation.

Results: The actuarial graft survival rate at 1 year and 5 years was 68% (95% CI, 47% to 82%) and 54% (CI, 25% to 77%), respectively, whereas the actuarial patient survival rate was 87% (CI, 69% to 96%) at 1 and 5 years. High disease activity was not found to affect graft survival adversely before the start of renal replacement therapy or during dialysis. After transplantation, disease activity per patient and the overall incidence of disease exacerbations decreased. One case of recurrent lupus nephritis was seen.

Conclusions: Patients with systemic lupus erythematosus and end-stage renal failure are excellent candidates for renal transplantation; disease activity after transplantation is sporadic and low, and the recurrence of lupus nephritis is rare.





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