Author: Leo
Keywords: lupus nephritis
There was no death in the LN group, and ESRD occurred in 3 cases (16.7%). The time of ESRD was 32,35,111 months after renal transplantation. The renal survival rate was 1 year, 5 years and 10 years after renal transplantation %, 88.9%, 83.3%. In the control group, one patient died and 10 (13.9%) had ESRD. The renal survival rate was 100%, 93.1% and 88.9% (Figure 1) after 1 year, 5 years and 10 years after renal transplantation. There was no significant difference between the LN group and the control group (P = 0.58).
Five, discussion
(1) International study of long-term prognosis of renal transplantation in patients with lupus nephritis
Renal transplantation is an effective method for the treatment of end-stage LN and has been widely used in LN-ESRD patients. There are many studies on the long-term prognosis of renal transplantation in LN-ESRD patients. Most of them are single center, small sample research, research methods and results are different, and the conclusion is not consistent. So far, multi-center, large sample of research data from the US kidney data system (USRDS) and the US transplant organ network database (UNOS), but the findings are not consistent.
Ward et al. Reported a comparison of 772 patients with USRDS from 1987 to 1994 and 32644 patients with non-LN renal transplantation. The results showed that the 1-year, 3-year, and 5-year renal survival rates of LN patients were 79.1%, 67% and 58.1 % And the survival rate were 94.4%, 89.6% and 83.8% respectively. There was no difference in renal survival rate between the two groups.
Bunnapradist et al. Used the UNOS database to compare the prognosis of 1170 cases of LN and 42651 cases of non-LN patients from 1996 to 2000. The results showed that the 1-year, 3-year and 5-year renal survival rates of LN patients were 88.6%, 77.4% and 67.8% The survival rates were 94.4%, 88.8% and 85.2%, respectively. There was no difference in renal survival rate between the two groups.
Chelamcharla used the USRDS and UNOS databases to compare the long-term prognosis of renal transplantation in 2886 cases of LN and 89958 cases of non LN patients from 1990 to 1999. 86% of patients with LN, 1 year, 3 years and 5 years were 86% % And 33% respectively. The survival rates were 96%, 68% and 44%, respectively. The survival rate of LN group was lower than that of control group. There is no definitive conclusion about the long-term prognosis of renal transplantation in LN patients, which may be related to the selection criteria and the selection of the control group.
(2) lead to LN patients transplanted kidney failure is the main reason?
The primary cause of renal failure in LN patients was rejection (approximately 43%). Studies have suggested that patients who received cadaveric transplantation were more likely to experience renal allograft dysfunction than those receiving live donor kidney. High PRA levels are also one of the factors that affect the prognosis of the transplanted kidney. When the PRA ≥ 50%, the risk of graft failure is increased. Because LN patients have higher levels of their own PRA, most of the studies have not been adjusted according to PRA levels when comparing the prognosis of LN patients with renal transplantation, and therefore may overestimate the proportion of transplanted renal failure in LN patients. Although the study found that blacks were risk factors for transplanted kidney failure, the Contreras team compared the long-term prognosis of blacks and Caucasians after excluding confounding factors such as social factors, immune factors, transplant conditions, LN recurrence and rejection , That the risk of both transplanted kidney no difference.
(3) How can LN patients choose to undergo kidney transplant surgery?
The clinical characteristics of LN patients undergoing renal transplant surgery significantly affected the survival rate of the transplanted kidney. When the patient's serum anticardiolipin antibody positive, patients receiving renal transplantation after the risk of thrombosis increased, the risk of graft failure also increased, this part of the application of heparin can reduce the incidence of thrombosis, but long-term use of anticoagulant drugs There is bleeding and other risks, clinicians need to pay close attention to this part of the patient's blood clotting state and the occurrence of thrombosis. Because LN patients receive long-term hormone and immunosuppressive therapy before renal transplantation, it is recommended to delay the time of renal transplant surgery and reduce the probability of infection after renal transplantation. Plantinga and so on that LN patients before renal transplantation before dialysis time <3 months will increase the risk of renal failure, and patients with longer dialysis time the risk of renal failure did not reduce. Therefore, clinicians need to assess the patient's lupus activity, had received hormones and immunosuppressive agents dose, dialysis time and other factors, select the appropriate timing of surgery.
(4) how to prevent cardiovascular events in patients with SLE?
SLE patients are more likely to develop atherosclerosis, so this part of the patients have a higher risk of cardiovascular events. LN patients after renal transplantation, the risk of cardiovascular events is also higher than the control group, the occurrence of cardiovascular events is an important factor affecting the survival rate of this part of the patient. Studies have shown that patients with LN after renal transplantation as a basic treatment can reduce the risk of cardiovascular events, improve the patient's long-term prognosis. This suggests that clinicians should assess blood lipids in patients undergoing kidney transplantation and closely monitor their lipid metabolism. For patients with lipid metabolic disorders, statins should be used to prevent atherosclerosis and reduce cardiovascular events The risk of improving its long-term prognosis.
(5) What are the risk factors for relapse after LN transplantation? How to prevent
LN recurrence rate of 1.8% to 54%, some researchers believe that this part of the LN recurrence of patients with low risk (usually <5%), there are some studies show that some patients with recurrence rate of about 10% Another part of the study shows that the recurrence rate of this part of the patients as high as 30% to 54%, the greater the difference between the main reason for the recurrence of recurrence and renal biopsy is different. The time of recurrence of LN after transplant is from 5 days to 8 years, and the time span is larger. Renal biopsy confirmed that the main type of recurrence of type Ⅰ / Ⅱ type LN, mostly mild mesangial proliferative and atypical oligodynic complex deposition glomerular nephritis mainly. Black, female and age <33 years are independent risk factors for LN recurrence after renal transplantation. Living kidney transplantation and LN recurrence also have a certain association, which may be related to SLE family genetic aggregation tendency. After transplantation, the use of hormones, cyclophosphamide, or mycophenolate mofetil, tacrolimus, cyclosporine A and other immunosuppressive drugs can reduce the risk of LN recurrence, but can not reduce the incidence of graft nephropathy, select different The effect of immunosuppressive agents on LN recurrence was not different. Contreras et al. Conducted a multi-center study of the largest sample size, incorporating 6850 patients with LN who underwent renal transplantation, suggesting that renal recurrence in LN recurrence was due to graft rejection and only 7% of LN recur Transplanted kidney failure. Most single-site studies suggest that LN recurrence after transplantation is usually benign and does not affect the patient's long-term survival rate.
This study observed the long-term prognosis of renal transplantation in 18 patients with LN. The survival rate of both groups was higher than that of USRDS and UNOS. The data of USRDS and UNOS were data of patients before 2000. With the improvement of medical technique and the renewal of immunosuppressive program, Human and renal survival rates have increased significantly. A recent study of the large number of renal transplant recipients in patients with renal transplantation has reported that the renal survival rate in patients undergoing renal transplantation in this study is similar to that of other single-center small sample studies. This study attempts to use COX regression to analyze the risk factors for renal survival, but because of the small sample size failed.
There are only one report on the long-term follow-up of LN renal transplantation in China. He Qiang et al. Analyzed the prognosis of renal transplantation in 11 cases of LN patients. It was concluded that LN-ESRD patients could safely receive renal transplantation. At this stage, the combined immunosuppressive regimen Can better control the recurrence of LN.
In this study, LN patients after renal transplantation using standard immunosuppressive therapy, only 1 case of LN recurrence, the recurrence rate was 5.6%. Patients with follow-up time> 10 years, did not appear graft kidney failure, suggesting that LN recurrence after transplantation did not affect the patient's long-term people, kidney survival. In this study, due to the small sample size, failed to arrive at the risk of recurrence of LN risk factors.
Summary: LN patients with renal transplantation in the long-term prognosis is better, renal transplant surgery into the ESRD LN patients is a good choice.
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