Outcome of Kidney Transplant in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Jesmar Buttigieg (Corresponding Author), Lorna Henderson, Dana Kidder

Research output: Contribution to journalArticle

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Abstract

Objectives: Kidney transplant outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis are comparable with outcomes in patients transplanted for other causes. Here, we report our single center experience of kidney transplant in patients with this condition and a pooled analysis of published studies.

Materials and Methods: This retrospective study included all patients with end-stage kidney disease secondary to antineutrophil cytoplasmic antibody-associated vasculitis who received a kidney transplant between 1987 and 2013 in the East of Scotland. We examined patient and graft survival and disease recurrence after transplant. We also performed a pooled analysis of published literature.

Results: We identified 24 patients who received a total of 31 kidney allografts. Median age at first transplant was 45.5 years (range, 18-68 y), and median follow-up after transplant was 60 months (range, 0.5-226 mo). All patients were positive for antineutrophil cyto­plasmic antibody (71% by proteinase 3 and 29% by myeloperoxidase) at diagnosis. Patient survival at 1 and 5 years was 92% and 88%, with corresponding death-censored allograft survival of 93% and 71%. Overall patient and allograft relapse rates were 0.022 and 0.016 relapse/patient-years. The pooled analysis comprised 20 studies (1169 patients). Patient/graft survival ranged from 64% to 80%/77% to 100% at 5 years and from 60% to 100%/59% to 84% at 10 years. Relapse rate was significantly higher in patients with positive antineutrophil cytoplasmic antibody at transplant (14% vs 5%; P = .042).

Conclusions: Our experience shows that kidney transplant remains a safe option for patients with end-stage kidney disease secondary to antineutrophil cytoplasmic antibody-associated vasculitis. Disease relapse posttransplant is uncommon and associated with pretransplant relapse. Pooled analyses suggest that relapse rate is higher in patients with positive antineutrophil cytoplasmic antibody at transplant. Multicenter registry data are needed to define renal outcome predictors in antineutrophil cytoplasmic antibody-associated vasculitis.
Original languageEnglish
Pages (from-to)509-515
Number of pages7
JournalExperimental and Clinical Transplantation
Volume15
Issue number5
Early online date20 Oct 2016
DOIs
Publication statusPublished - 1 Oct 2017

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Antineutrophil Cytoplasmic Antibodies
Vasculitis
Transplants
Kidney
Recurrence
Allografts
Graft Survival
Chronic Kidney Failure
Myeloblastin
Scotland

Keywords

  • autoimmune diseases
  • glomerulonephritis
  • immunosuppression
  • recurrence
  • remission induction

Cite this

Outcome of Kidney Transplant in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. / Buttigieg, Jesmar (Corresponding Author); Henderson, Lorna; Kidder, Dana.

In: Experimental and Clinical Transplantation, Vol. 15, No. 5, 01.10.2017, p. 509-515.

Research output: Contribution to journalArticle

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title = "Outcome of Kidney Transplant in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis",
abstract = "Objectives: Kidney transplant outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis are comparable with outcomes in patients transplanted for other causes. Here, we report our single center experience of kidney transplant in patients with this condition and a pooled analysis of published studies.Materials and Methods: This retrospective study included all patients with end-stage kidney disease secondary to antineutrophil cytoplasmic antibody-associated vasculitis who received a kidney transplant between 1987 and 2013 in the East of Scotland. We examined patient and graft survival and disease recurrence after transplant. We also performed a pooled analysis of published literature.Results: We identified 24 patients who received a total of 31 kidney allografts. Median age at first transplant was 45.5 years (range, 18-68 y), and median follow-up after transplant was 60 months (range, 0.5-226 mo). All patients were positive for antineutrophil cyto­plasmic antibody (71{\%} by proteinase 3 and 29{\%} by myeloperoxidase) at diagnosis. Patient survival at 1 and 5 years was 92{\%} and 88{\%}, with corresponding death-censored allograft survival of 93{\%} and 71{\%}. Overall patient and allograft relapse rates were 0.022 and 0.016 relapse/patient-years. The pooled analysis comprised 20 studies (1169 patients). Patient/graft survival ranged from 64{\%} to 80{\%}/77{\%} to 100{\%} at 5 years and from 60{\%} to 100{\%}/59{\%} to 84{\%} at 10 years. Relapse rate was significantly higher in patients with positive antineutrophil cytoplasmic antibody at transplant (14{\%} vs 5{\%}; P = .042).Conclusions: Our experience shows that kidney transplant remains a safe option for patients with end-stage kidney disease secondary to antineutrophil cytoplasmic antibody-associated vasculitis. Disease relapse posttransplant is uncommon and associated with pretransplant relapse. Pooled analyses suggest that relapse rate is higher in patients with positive antineutrophil cytoplasmic antibody at transplant. Multicenter registry data are needed to define renal outcome predictors in antineutrophil cytoplasmic antibody-associated vasculitis.",
keywords = "autoimmune diseases, glomerulonephritis, immunosuppression, recurrence, remission induction",
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T1 - Outcome of Kidney Transplant in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

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AU - Henderson, Lorna

AU - Kidder, Dana

N1 - Acknowledgements: The authors declare that they have no sources of funding for this study, and they have no conflicts of interest to disclose.

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N2 - Objectives: Kidney transplant outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis are comparable with outcomes in patients transplanted for other causes. Here, we report our single center experience of kidney transplant in patients with this condition and a pooled analysis of published studies.Materials and Methods: This retrospective study included all patients with end-stage kidney disease secondary to antineutrophil cytoplasmic antibody-associated vasculitis who received a kidney transplant between 1987 and 2013 in the East of Scotland. We examined patient and graft survival and disease recurrence after transplant. We also performed a pooled analysis of published literature.Results: We identified 24 patients who received a total of 31 kidney allografts. Median age at first transplant was 45.5 years (range, 18-68 y), and median follow-up after transplant was 60 months (range, 0.5-226 mo). All patients were positive for antineutrophil cyto­plasmic antibody (71% by proteinase 3 and 29% by myeloperoxidase) at diagnosis. Patient survival at 1 and 5 years was 92% and 88%, with corresponding death-censored allograft survival of 93% and 71%. Overall patient and allograft relapse rates were 0.022 and 0.016 relapse/patient-years. The pooled analysis comprised 20 studies (1169 patients). Patient/graft survival ranged from 64% to 80%/77% to 100% at 5 years and from 60% to 100%/59% to 84% at 10 years. Relapse rate was significantly higher in patients with positive antineutrophil cytoplasmic antibody at transplant (14% vs 5%; P = .042).Conclusions: Our experience shows that kidney transplant remains a safe option for patients with end-stage kidney disease secondary to antineutrophil cytoplasmic antibody-associated vasculitis. Disease relapse posttransplant is uncommon and associated with pretransplant relapse. Pooled analyses suggest that relapse rate is higher in patients with positive antineutrophil cytoplasmic antibody at transplant. Multicenter registry data are needed to define renal outcome predictors in antineutrophil cytoplasmic antibody-associated vasculitis.

AB - Objectives: Kidney transplant outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis are comparable with outcomes in patients transplanted for other causes. Here, we report our single center experience of kidney transplant in patients with this condition and a pooled analysis of published studies.Materials and Methods: This retrospective study included all patients with end-stage kidney disease secondary to antineutrophil cytoplasmic antibody-associated vasculitis who received a kidney transplant between 1987 and 2013 in the East of Scotland. We examined patient and graft survival and disease recurrence after transplant. We also performed a pooled analysis of published literature.Results: We identified 24 patients who received a total of 31 kidney allografts. Median age at first transplant was 45.5 years (range, 18-68 y), and median follow-up after transplant was 60 months (range, 0.5-226 mo). All patients were positive for antineutrophil cyto­plasmic antibody (71% by proteinase 3 and 29% by myeloperoxidase) at diagnosis. Patient survival at 1 and 5 years was 92% and 88%, with corresponding death-censored allograft survival of 93% and 71%. Overall patient and allograft relapse rates were 0.022 and 0.016 relapse/patient-years. The pooled analysis comprised 20 studies (1169 patients). Patient/graft survival ranged from 64% to 80%/77% to 100% at 5 years and from 60% to 100%/59% to 84% at 10 years. Relapse rate was significantly higher in patients with positive antineutrophil cytoplasmic antibody at transplant (14% vs 5%; P = .042).Conclusions: Our experience shows that kidney transplant remains a safe option for patients with end-stage kidney disease secondary to antineutrophil cytoplasmic antibody-associated vasculitis. Disease relapse posttransplant is uncommon and associated with pretransplant relapse. Pooled analyses suggest that relapse rate is higher in patients with positive antineutrophil cytoplasmic antibody at transplant. Multicenter registry data are needed to define renal outcome predictors in antineutrophil cytoplasmic antibody-associated vasculitis.

KW - autoimmune diseases

KW - glomerulonephritis

KW - immunosuppression

KW - recurrence

KW - remission induction

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DO - 10.6002/ect.2016.0058

M3 - Article

VL - 15

SP - 509

EP - 515

JO - Experimental and Clinical Transplantation

JF - Experimental and Clinical Transplantation

SN - 1304-0855

IS - 5

ER -