Premature cardiovascular disease in patients with systemic lupus erythematosus influences survival after renal transplantation

• Published in: Arthritis & rheumatology (Hoboken, N.J.) N.J.), 2011-03, Vol.63 (3), p.733-737
• Main Authors: Norby, Gudrun E., Leivestad, Torbjørn, Mjøen, Geir, Hartmann, Anders, Midtvedt, Karsten, Gran, Jan T., Holdaas, Hallvard
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Biological and medical sciences; Cardiovascular Diseases - mortality; Chronic Disease; Diseases of mother, fetus and pregnancy; Diseases of the osteoarticular system; Female; Glomerulonephritis - mortality; Glomerulonephritis - surgery; Graft Rejection - mortality; Graft Survival; Gynecology. Andrology. Obstetrics; Humans; Kidney Transplantation - mortality; Living Donors - statistics & numerical data; Lupus Erythematosus, Systemic - mortality; Lupus Nephritis - mortality; Lupus Nephritis - surgery; Male; Medical sciences; Middle Aged; Pregnancy. Fetus. Placenta; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Survival Analysis
• ISSN: 0004-3591; 2326-5191; 1529-0131; 2326-5205
• DOI: 10.1002/art.30184

Objective To assess graft and patient survival as well as causes for graft loss and patient death after renal transplantation in patients with systemic lupus erythematosus (SLE). Methods Eighty‐seven renal transplantations were performed in 77 patients with SLE from 1972 to 2005. Each recipient with SLE was matched (for date of transplant, age, donor source [living versus deceased], and sex) with 2 renal graft recipients who had non‐SLE glomerulonephritis, and the SLE and non‐SLE groups were compared with regard to graft survival and patient survival. Results The mean ± SD age of SLE patients at the time of transplantation was 37.4 ± 12.8 years, and the majority of SLE patients were female (80.5%). SLE patients were well matched to control transplant patients for date of transplant, age, and donor source (living versus deceased donor). The death‐censored graft survival rate for SLE patients receiving transplants corresponded closely to that for the control groups; the 1‐, 5‐, and 10‐year graft survival rates were 88%, 81%, and 71%, respectively, for SLE patients, and 91%, 83%, and 74%, respectively, for patients with non‐SLE glomerulonephritis (P = 0.31). Patient survival differed significantly; the rates of survival for recipients with SLE were 94%, 83%, and 71% at 1, 5, and 10 years, respectively. The corresponding rates of patient survival in the non‐SLE glomerulonephritis cohort were 96%, 92%, and 85% (P = 0.018). Cardiovascular events were the most prominent cause of death in SLE patients (66.7%, versus 39.5% in the control group; P = 0.03). Conclusion Transplant patients with SLE have a graft survival rate that matches that of recipients with non‐SLE glomerulonephritis. SLE patients who receive transplants have a lower survival rate than control patients. The excessive mortality in SLE is attributed to a greater number of cardiovascular deaths.