Trasplante renal en lupus eritematoso sistémico: comparación de la supervivencia del injerto con otras causas de enfermedad renal terminal

Resumen Introducción La enfermedad renal terminal (ERT) por nefritis lúpica (NL) se presenta en el 10-30% de los pacientes. Inicialmente, el lupus eritematoso sistémico (LES) fue una contraindicación para el trasplante renal (TR). En la actualidad, la supervivencia del injerto a largo plazo sigue si...

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Published inReumatología clinica Vol. 15; no. 3; pp. 140 - 145
Main Authors Horta-Baas, Gabriel, Camargo-Coronel, Adolfo, Miranda-Hernández, Dafhne Guadalupe, Gónzalez-Parra, Leslie Gabriela, Romero-Figueroa, María del Socorro, Pérez-Cristóbal, Mario
Format Journal Article
LanguageSpanish
Published Elsevier España, S.L.U 01.05.2019
Subjects
Kidney transplantation
Lupus eritematoso sistémico
Lupus nephritis
Nefropatía lúpica
Rheumatology
Systemic lupus erythematosus
Trasplante renal
Systemic lupus erythematosus
Lupus nephritis
Trasplante renal
Nefropatía lúpica
Lupus eritematoso sistémico
Kidney transplantation
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Abstract Resumen Introducción La enfermedad renal terminal (ERT) por nefritis lúpica (NL) se presenta en el 10-30% de los pacientes. Inicialmente, el lupus eritematoso sistémico (LES) fue una contraindicación para el trasplante renal (TR). En la actualidad, la supervivencia del injerto a largo plazo sigue siendo motivo de controversia. El objetivo del estudio fue comparar la supervivencia del TR en los sujetos con LES con otras causas de ERT. Métodos Se incluyó a todos los pacientes con TR en sujetos con LES, de una cohorte retrospectiva en 2 centros de trasplante. Se realizó un grupo de comparación con otras etiologías de ERT en una relación 2:1 emparejados por edad, sexo y año del trasplante. La supervivencia se evaluó por el método de Kaplan-Meier y por el modelo de riesgos proporcionales de Cox. Resultados Se incluyó a 25 sujetos con LES. La probabilidad de supervivencia en los sujetos con LES al año, 5 y 10 años fue del 92, el 66 y el 66%, respectivamente, la cual no difirió del grupo de comparación (p = 0,39). En el análisis multivariante no existió una diferencia significativa en la supervivencia del injerto entre los 2 grupos (hazard ratio = 1.95, IC del 95%, 0,57-6,61; p = 0,28). La recurrencia de la NL fue del 8% y no se relacionó con la pérdida del injerto. El rechazo agudo fue la única variable asociada con la pérdida del injerto en los sujetos con LES (HR 16,5, IC del 95%, 1,94-140,1, p = 0,01). Conclusiones El riesgo de pérdida del injerto renal en los sujetos con LES fue similar al de los sujetos con otras causas de ERT.
AbstractList La enfermedad renal terminal (ERT) por nefritis lúpica (NL) se presenta en el 10-30% de los pacientes. Inicialmente, el lupus eritematoso sistémico (LES) fue una contraindicación para el trasplante renal (TR). En la actualidad, la supervivencia del injerto a largo plazo sigue siendo motivo de controversia. El objetivo del estudio fue comparar la supervivencia del TR en los sujetos con LES con otras causas de ERT. Se incluyó a todos los pacientes con TR en sujetos con LES, de una cohorte retrospectiva en 2 centros de trasplante. Se realizó un grupo de comparación con otras etiologías de ERT en una relación 2:1 emparejados por edad, sexo y año del trasplante. La supervivencia se evaluó por el método de Kaplan-Meier y por el modelo de riesgos proporcionales de Cox. Se incluyó a 25 sujetos con LES. La probabilidad de supervivencia en los sujetos con LES al año, 5 y 10 años fue del 92, el 66 y el 66%, respectivamente, la cual no difirió del grupo de comparación (p=0,39). En el análisis multivariante no existió una diferencia significativa en la supervivencia del injerto entre los 2 grupos (hazard ratio=1.95, IC del 95%, 0,57-6,61; p=0,28). La recurrencia de la NL fue del 8% y no se relacionó con la pérdida del injerto. El rechazo agudo fue la única variable asociada con la pérdida del injerto en los sujetos con LES (HR 16,5, IC del 95%, 1,94-140,1, p=0,01). El riesgo de pérdida del injerto renal en los sujetos con LES fue similar al de los sujetos con otras causas de ERT. End-stage renal disease (ESRD) due to lupus nephritis (LN) occurs in 10%-30% of patients. Initially systemic lupus erythematosus (SLE) was a contraindication for kidney transplantation (KT). Today, long-term graft survival remains controversial. Our objective was to compare the survival after KT in patients with SLE or other causes of ESRD. All SLE patients who had undergone KT in a retrospective cohort were included. Renal graft survival was compared with that of 50 controls, matched for age, sex, and year of transplantation. Survival was evaluated by the Kaplan-Meier test and the Cox proportional hazards model. Twenty-five subjects with SLE were included. The estimated 1-year, 2- and 5-year survival rates for patients with SLE were 92%, 66% and 66%. Renal graft survival did not differ between patients with SLE and other causes of ESRD (P=.39). The multivariate analysis showed no significant difference in graft survival between the two groups (hazard ratio, HR=1.95, 95% confidence interval [CI] 0.57-6.61, P=.28). The recurrence rate of LN was 8% and was not associated with graft loss. Acute rejection was the only variable associated with graft loss in patients with SLE (HR=16.5, 95% CI 1.94-140.1, P=.01). Renal graft survival in SLE patients did not differ from that reported for other causes of ESRD.
Resumen Introducción La enfermedad renal terminal (ERT) por nefritis lúpica (NL) se presenta en el 10-30% de los pacientes. Inicialmente, el lupus eritematoso sistémico (LES) fue una contraindicación para el trasplante renal (TR). En la actualidad, la supervivencia del injerto a largo plazo sigue siendo motivo de controversia. El objetivo del estudio fue comparar la supervivencia del TR en los sujetos con LES con otras causas de ERT. Métodos Se incluyó a todos los pacientes con TR en sujetos con LES, de una cohorte retrospectiva en 2 centros de trasplante. Se realizó un grupo de comparación con otras etiologías de ERT en una relación 2:1 emparejados por edad, sexo y año del trasplante. La supervivencia se evaluó por el método de Kaplan-Meier y por el modelo de riesgos proporcionales de Cox. Resultados Se incluyó a 25 sujetos con LES. La probabilidad de supervivencia en los sujetos con LES al año, 5 y 10 años fue del 92, el 66 y el 66%, respectivamente, la cual no difirió del grupo de comparación (p = 0,39). En el análisis multivariante no existió una diferencia significativa en la supervivencia del injerto entre los 2 grupos (hazard ratio = 1.95, IC del 95%, 0,57-6,61; p = 0,28). La recurrencia de la NL fue del 8% y no se relacionó con la pérdida del injerto. El rechazo agudo fue la única variable asociada con la pérdida del injerto en los sujetos con LES (HR 16,5, IC del 95%, 1,94-140,1, p = 0,01). Conclusiones El riesgo de pérdida del injerto renal en los sujetos con LES fue similar al de los sujetos con otras causas de ERT.
Author Romero-Figueroa, María del Socorro
Pérez-Cristóbal, Mario
Camargo-Coronel, Adolfo
Horta-Baas, Gabriel
Miranda-Hernández, Dafhne Guadalupe
Gónzalez-Parra, Leslie Gabriela
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Issue 3
Keywords Systemic lupus erythematosus
Lupus nephritis
Trasplante renal
Nefropatía lúpica
Lupus eritematoso sistémico
Kidney transplantation
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Snippet Resumen Introducción La enfermedad renal terminal (ERT) por nefritis lúpica (NL) se presenta en el 10-30% de los pacientes. Inicialmente, el lupus eritematoso...
La enfermedad renal terminal (ERT) por nefritis lúpica (NL) se presenta en el 10-30% de los pacientes. Inicialmente, el lupus eritematoso sistémico (LES) fue...
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SubjectTerms Kidney transplantation
Lupus eritematoso sistémico
Lupus nephritis
Nefropatía lúpica
Rheumatology
Systemic lupus erythematosus
Trasplante renal
Title Trasplante renal en lupus eritematoso sistémico: comparación de la supervivencia del injerto con otras causas de enfermedad renal terminal
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https://dx.doi.org/10.1016/j.reuma.2017.07.006
Volume 15
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