Renal Transplant Safe, Successful in Wegener's Granulomatosis
Renal Transplant Safe, Successful in Wegener's Granulomatosis
Nov. 4, 2002 — Although Wegener's granulomatosis is a systemic disease, renal graft and patient survival after transplantation are not impaired compared with those of nonsystemic diseases, according to a presentation on Nov. 3 at the American Society of Nephrology annual meeting in Philadelphia, Pennsylvania. Which immunosuppressive therapy was used for renal transplantation was not significant.
"End-stage renal disease develops in 25% of patients with Wegener's granulomatosis (WG)," write Wilhelm H. Schmitt, from University Hospital Mannheim in Germany, and colleagues. "Although renal transplantation became a therapeutic option for these patients, data on prognosis and outcome after renal transplantation are limited."
Schmitt's group compared outcome after first cadaver renal transplantation between 1985 and 2000 in 378 patients with WG; 3,912 with IgA nephropathy; 1,220 with membrano-proliferative glomerulonephritis; 14,482 with polycystic kidney disease; and 15,584 with diabetic nephropathy. Recipients with WG were older (mean age, 47.2 years) than those with IgA nephropathy (41.8 years; P<.0001) or membrano-proliferative glomerulonephritis (39.6 years; P<.0001).
Ten-year patient survival in WG was 80.0%, similar to that in membrano-proliferative glomerulonephritis (79.3%), but lower than in IgA nephropathy (84.5%; P<.005), and higher than in polycystic kidney disease (70.9%; P<.05) and in diabetic nephropathy (49.3%; P<.0001). Ten-year graft survival in WG was 65.4%, similar to that in IgA nephropathy (63.3%) and in polycystic kidney disease (72.4%) and better than that in membrano-proliferative glomerulonephritis (52.4%; P<.0001).
In WG, use of haplotype-related kidney improved 10-year graft survival (84.9% vs. 65.4%), but not patient survival. Triple immunosuppressive therapy including azathioprine (n=202) or mycophenolate mofetil (n=54) was not associated with improved three- and five-year graft survival when compared with cyclosporin A plus steroids alone (n=94).
"Although WG is a multisystem autoimmune disorder, patient and graft survival is not impaired as compared with non-systemic renal disorders," the authors write. "Different immunosuppressive regimens were not associated with differences in outcomes."
ASN 35th Annual Meeting: Abstract SU-P0474. Presented Nov. 3, 2002.
Reviewed by Gary D. Vogin, MD
Nov. 4, 2002 — Although Wegener's granulomatosis is a systemic disease, renal graft and patient survival after transplantation are not impaired compared with those of nonsystemic diseases, according to a presentation on Nov. 3 at the American Society of Nephrology annual meeting in Philadelphia, Pennsylvania. Which immunosuppressive therapy was used for renal transplantation was not significant.
"End-stage renal disease develops in 25% of patients with Wegener's granulomatosis (WG)," write Wilhelm H. Schmitt, from University Hospital Mannheim in Germany, and colleagues. "Although renal transplantation became a therapeutic option for these patients, data on prognosis and outcome after renal transplantation are limited."
Schmitt's group compared outcome after first cadaver renal transplantation between 1985 and 2000 in 378 patients with WG; 3,912 with IgA nephropathy; 1,220 with membrano-proliferative glomerulonephritis; 14,482 with polycystic kidney disease; and 15,584 with diabetic nephropathy. Recipients with WG were older (mean age, 47.2 years) than those with IgA nephropathy (41.8 years; P<.0001) or membrano-proliferative glomerulonephritis (39.6 years; P<.0001).
Ten-year patient survival in WG was 80.0%, similar to that in membrano-proliferative glomerulonephritis (79.3%), but lower than in IgA nephropathy (84.5%; P<.005), and higher than in polycystic kidney disease (70.9%; P<.05) and in diabetic nephropathy (49.3%; P<.0001). Ten-year graft survival in WG was 65.4%, similar to that in IgA nephropathy (63.3%) and in polycystic kidney disease (72.4%) and better than that in membrano-proliferative glomerulonephritis (52.4%; P<.0001).
In WG, use of haplotype-related kidney improved 10-year graft survival (84.9% vs. 65.4%), but not patient survival. Triple immunosuppressive therapy including azathioprine (n=202) or mycophenolate mofetil (n=54) was not associated with improved three- and five-year graft survival when compared with cyclosporin A plus steroids alone (n=94).
"Although WG is a multisystem autoimmune disorder, patient and graft survival is not impaired as compared with non-systemic renal disorders," the authors write. "Different immunosuppressive regimens were not associated with differences in outcomes."
ASN 35th Annual Meeting: Abstract SU-P0474. Presented Nov. 3, 2002.
Reviewed by Gary D. Vogin, MD
