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Editorials |22 January 2019

Kidney Transplantation in Lupus Nephritis: Can We Do Even Better?

Nitender Goyal, MD; Daniel E. Weiner, MD, MS; Andrew S. Levey, MD

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This article was published at Annals.org on 22 January 2019.
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The risk for kidney failure from lupus nephritis (LN) is high and has not changed in the past 20 years despite advances in diagnostic and treatment options for systemic lupus erythematosus. The United States Renal Data System collects data on all U.S. patients who receive dialysis or a transplant to treat end-stage renal disease (ESRD) (1). Approximately 2% of the U.S. dialysis population has ESRD due to LN (1).
In the early years of kidney transplantation, patients with LN were not considered acceptable recipients because of concern about recurrent disease and accelerated rejection. Many studies have since demonstrated satisfactory outcomes, and kidney transplant is now a well-established treatment option for patients with LN. However, concern remains that these patients may have increased risk for complications after transplant due to either ongoing immunologic activity, including thrombotic events, or complications related to pretransplant immunosuppressive therapy. Many providers suggest a waiting period while patients receive dialysis to allow immune activity to “burn out” before proceeding to transplant (2). Reports using data from the United States Renal Data System show a survival advantage of kidney transplant versus dialysis for patients healthy enough to be on the waitlist (3). However, these studies have not specifically evaluated the benefits of kidney transplant in patients with LN.
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Goyal N, Weiner DE, Levey AS. Kidney Transplantation in Lupus Nephritis: Can We Do Even Better?. Ann Intern Med. [Epub ahead of print ]:. doi: 10.7326/M18-3721

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Published: Ann Intern Med. 2019.

DOI: 10.7326/M18-3721

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2019 American College of Physicians
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