Renal transplantation in anti-neutrophil cytoplasmic antibody-associated vasculitis.

Abstract

Despite major advances in the management of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) achieved in the last decades, a large proportion of AAV patients still develop end-stage renal disease. The survival of AAV patients dependent on dialysis is significantly worse compared with dialysis-independent AAV patients, but is comparable to other non-diabetic patients requiring dialysis. Renal transplantation (RTx) is the method of choice among renal replacement therapies and there has been increasing evidence that it is a suitable method with favorable patient- and graft-survival also in AAV patients. It is recommended to perform RTx after ≥12 months of remission, and ANCA positivity at the time of RTx is generally not considered a contraindication. Even though the risk of relapse after RTx is relatively low with current post-transplant immunosuppressive regimens, disease recurrence may occur. Besides cyclophosphamide, rituximab might become a therapeutic alternative for post-transplant AAV recurrence in the near future but its efficacy and safety in this setting needs to be confirmed in larger studies.

• Authors: Zdenka Hruskova, Duvuru Geetha, Vladimir Tesar
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 30 Suppl 1 Pg. i159-63 (Apr 2015) ISSN: 1460-2385 [Electronic] England
• PMID: 25324359 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Topics

• Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis (complications, therapy)
• Graft Survival
• Humans
• Kidney Diseases (etiology, surgery)
• Kidney Transplantation
• Remission Induction