Kidney Transplants Generally Safe for Lupus Patients

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This article is part of our coverage of Renal Week 2009. Click here for a complete list of our Renal Week Live articles.


Key Points

  • Lupus patients who receive kidney transplants rarely develop lupus nephritis in their new allograft.
  • Lupus should not keep individuals from seeking a kidney transplant if they need one, said investigators.
  • The study also found that the development of RLN can be predicted by race-ethnicity, gender, and age of the recipients.

SAN DIEGO—Contrary to previous studies, lupus patients who receive kidney transplants rarely develop lupus nephritis (LN) in their new allograft.

New data from a case-controlled study of 6,850 patients with systemic lupus erythematosus (SLE) indicate that recurrent lupus nephritis (RLN) seems uncommon in SLE recipients of a kidney allograft. However, when RLN does occur it commonly leads to allograft failure with an increased risk for death after transplantation.

The study, presented here at the American Society of Nephrology's Renal Week conference, also found that the development of RLN can be predicted by race-ethnicity, gender, and age of the recipients.

“Our findings indicate that having lupus should not keep individuals from seeking a kidney transplant if they need one,” said lead investigator Gabriel Contreras, MD, MPH, who is Associate Professor of Medicine at the University of Miami.

Previous studies have provided conflicting results about the incidence and severity of SLE in patients who receive a kidney allograft. Some studies concluded there were few consequences while others found that the condition can increase the risk of kidney failure and the risk of death. 

Using data from the United Network for Organ Sharing, Dr. Contreras and colleagues studied patients with a history of lupus who received kidney allografts between 1987 and 2006. They found that RLN developed in only 2.4% of subjects. When RLN did occur, it was associated with a fourfold increased relative risk of kidney transplant failure. However, graft loss attributable to RLN was only 7%.

During the study period of 19 years, 12.7% of patients died, with only 0.4% of dying patients coming from the group that developed RLN in their new kidney.

The investigators found that African Americans, women, and patients under the age of 33 years were at higher risk of developing RLN in their transplanted kidney. Receiving a kidney transplant before or after starting dialysis did not affect patients' risk.

Dr. Contreras, who presented the study findings at the American Society of Nephrologists Renal Week 2009 in San Diego, also said that the type of donor (deceased or living) had no effect on the recipients' risk of developing RLN.

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