Rheumatology Medical News about Renal transplantation, ANCA, Vasculitis, Vasculopathy

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Renal transplantation in systemic vasculitis: When is it safe
Nephrology Dialysis Transplantation, 07/22/09

Little MA et al. - Study reports that circulating antineutrophil cytoplasmic antibody (ANCA) at transplant was associated with the development of vascular lesions in the graft but was not significantly correlated with graft survival. Most grafts were lost due to patient death, which was more likely if transplantation occurred <12 months following induction of remission of ANCA-positive vasculitis.

Methods

A survey of transplant centres across Europe to assess whether there was consensus about how to manage transplantation in pts with vasculitis
107 renal allograft recipients were identified whose primary disease was systemic vasculitis
Their post-transplant outcome was assessed

Results

All questionnaire respondents felt that vasculitis should be in remission at transplantation:
- 16% believed that ANCA should be negative pre-transplant, and
- 40% felt that one should wait >12 mo after remission before transplanting
Remission was defined as:
- By all as an absence of clinical symptoms of vasculitis, but
- 3 respondents (13%) also required a negative ANCA test
Overall graft survival was 70% after 10 yrs
41% of those with known ANCA status were ANCA-positive peri-transplantation, while 14% were transplanted <1 year post-remission
Severe vasculopathy occurred more frequently in ANCA-positive recipients; causation could not be determined
Vasculopathy reduced 10-yr graft survival to 47%
However, ANCA status per se was not associated with graft failure
The strongest predictor of death was transplantation <1 year post-vasculitis remission on both univariate and multivariate analysis