Renal Transplantation in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Multicenter Experience

• Published in: Transplantation Vol. 91; no. 12; pp. 1370 - 1375
• Main Authors: GEETHA, Duvuru, EIRIN, Alfonso, TRUE, Karin, IRAZABAL, Maria Valentina, SPECKS, Ulrich, SEO, Philip, NACHMAN, Patrick, FERVENZA, Fernando C
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 27-06-2011
• Subjects: Adeno-associated virus; Adult; Age; Antibodies, Antineutrophil Cytoplasmic - blood; Antibodies, Antineutrophil Cytoplasmic - immunology; antineutrophil cytoplasmic antibodies; Biological and medical sciences; Cohort Studies; Creatinine; End-stage renal disease; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Glomerulonephritis; Graft rejection; Humans; Immunosuppression; Immunosuppressive Agents - therapeutic use; Kidney transplantation; Kidney Transplantation - methods; Male; Medical sciences; Middle Aged; Mycophenolate mofetil; Neutrophils - immunology; Prednisone; Recurrence; Remission; Renal Insufficiency - immunology; Renal Insufficiency - therapy; Retrospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival; Tacrolimus; Tissue, organ and graft immunology; Treatment Outcome; Vasculitis; Vasculitis - complications; Vasculitis - immunology; Wegener's granulomatosis; Antineutrophil cytoplasmic antibody; Multicenter study; Cardiovascular disease; Homotransplantation; Kidney; Vascular disease; Experience; Treatment; Vasculitis; Urinary system; Surgery; Graft; Kidney transplantation
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/TP.0b013e31821ab9aa

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a common cause of rapidly progressive glomerulonephritis resulting in end-stage renal disease (ESRD). The optimal timing of kidney transplantation (KTX) for ESRD as a result of AAV and the risk of AAV relapse after KTX are not well defined. We report our experience with AAV patients who underwent KTX at our institutions between 1996 and 2010. Median follow-up was 64 months.
Retrospective multicenter cohort study.
Eighty-five patients (45 men/40 women; mean age 49 years) received a KTX for ESRD secondary to microscopic polyangiitis (n=43) or Wegener's granulomatosis (n=42). Twenty-four patients underwent preemptive KTX and 69 received a living-donor KTX. All patients were in remission at the time of KTX. Fifty-eight patients received induction therapy. In 64 patients, maintenance immunosuppression was with prednisone, mycophenolate mofetil, and tacrolimus. At the time of KTX, 29 patients were ANCA-positive. The vasculitis relapse rate was 0.02 per patient-years and was not influenced by disease category, ANCA subtype, or remission duration before KTX. There were 23 rejection episodes in 13 patients with seven graft losses. Median serum creatinine at 1 year was 1.3 mg/dL in 75 patients with more than 1 year follow-up and 1.4 mg/dL at last follow-up. The graft and patient survival rates were 100% at 1 year, 97.9% and 93.4% at 5 years, and 79.0% and 67.4% at 10 years, respectively.
KTX is a safe and an effective option for treating ESRD secondary to AAV. Relapses are rare with current immunosuppression.