Long-Term Outcome and Evolution of Disease Activity in Systemic Lupus Erythematosus in Chinese Patients after Renal Transplantation

紅斑性狼瘡對腎臟移植病人長期預後影響之結果分析探討

游棟閔(Dong-Ming Yu) ； 藍忠亮(Joung-Lian Lan) ； 連榮達(Jong-Da Lian) ； 呂源三(Yuan-San Lu) ； 吳明儒(Ming-Ju Wu) ； 陳呈旭(Cheng-Hsu Chen) ； 李文欽(Wen-Chin Lee) ； 鄭志雄(Chi-Hung Cheng) ； 徐國雄(Kuo-Hsiung Shu)

《Acta Nephrologica》 20卷3期 (2006/07) Pp. 175-182

摘要

背景：因紅斑性狼瘡(SLE)所造成的腎衰竭病人接受腎臟移植後，病人和移植腎的長期存活率，目前仍無一致的結果。在移植後，紅斑性狼瘡復發所造成的移植腎衰竭仍是一個令人關心的問題。目前國內並無本上性的資料。本研究的目的，在觀察比較紅斑性狼瘡病人及非紅斑性狼瘡病人，在病人及移植腎長期存活率是否有差異；並且觀察紅斑性狼瘡疾病本身活性，在不同時期的變化與移植後復發的可能性。
方法：回溯性分析收集本院20年內紅斑性狼瘡末期腎病變接受腎臟移植病人共20位。利用case-matched control方式，根據病人年齡、性別、透析方式、透析時問、捐贈來源（活體或屍腎）、肝炎帶原、組織配對等因素，逐一選擇非紅斑性狼瘡的腎移植病人作為對照組。另外，利用SLEADI score作為紅斑性狼瘡疾病本身活動性指標，長期追蹤病人在不同時期，疾病的活性變化和復發的可能性。
研究結果：研究期間自1984年迄今，紅斑性狼瘡腎移植病人男性4位(15.8%)，女性16位(84.2%)，對照組共91位。兩組基本資料無統計巨之差異。紅斑性狼瘡移植組平均年齡為32.3±9.9歲，移植前透析時問平均為27.2±27.3月，追蹤時間為109.2±69.4月，與對照組無明顯不同。整體而言，紅斑性狼瘡病人10年存活率為94.4%，而移植腎存活率為66.6%，無明顯差異。在移植後，無因紅斑性狼瘡復發而造成移植腎衰竭。移植腎衰竭共有5例，原因為慢性排斥（2例），腎動脈栓塞（1例）、敗血性休克（1例）和原因不明（1例）。在末期腎病變的紅斑性狼瘡病人，臨床表現呈現靜滯狀態，然而血清學檢查仍現補體低和anti-ds DNA上升的狀態。整體排斥率為36.8%，發生期間在移植後1個月至41個月之間，其中有4例在1年之內發生。併發症主要原因為感染(53.3%)，血管壞死性骨關節病變(15%)。
結論：紅斑性狼瘡末期腎病變病人可作為適當的腎移植對象。病人與移植腎的長期存活率及預後，和其他原因的移植腎並無不同。

關鍵字

紅斑性狼瘡末期腎病變 ； 腎臟移植 ； 存活率

並列摘要

Background: The long-term outcome of renal transplantations caused by lupus nephritis and the issue of relapse of disease are still matters of controversy. Some studies reported inferior graft survival in patients with than without systemic lupus erythematous (SLE). The paper is to determine the long-term outcome of renal transplantation in end stage renal disease caused by lupus nephritis and the systemic lupus erythematous disease activity in different stages by the measurement of serial activity index change.
Material and Methods: Renal transplantation patients with an underlying disease of lupus nephritis and followed up at our hospital were recruited for retrospective analysis. A group of age and sex-matched non-lupus renal transplant patients served as control, Most of the patients were immunosupressed with triple therapy including corticosteroid, calcineurin inhibitor and antimetabolite. Lupus activity was evaluated periodically with serological tests. Patient and graft survival were calculated and compared.
Results: A total of 20 lupus patients undergoing renal transplantation were enrolled. The demographic data were not different significantly between the 2 groups. The mean duration of follow-up was 109.2±69.4 months. The overall patient and graft survival rates were 94.4% and 66.1% at 10 years posttransplant which were not significantly different than the control group (90.1% and 62.8%, respectively) Recurrence of lupus nephritis in renal allograft was not found in our study. Five grafts losses occurred in the SLE group .One patient expired one year after transplantation doe to pneumonia with septic shock. The others are alive until now. The lupus activity quenched when patient became ESRD and clinically represented burn-out appearance. Acute rejection rate throughout whole course of allograft in the SLE group is 36.8%. Complications of lupus transplant group were infection (45%) and avascular necrosis of femoral neck or knee (15%).
Conclusions: Patients with end stage renal disease caused by lupus nephritis are suitable candidates for renal transplantation. The patient and graft survival rate is comparable to that of ESRD caused by other diseases. Flare-up of lupus activity was not observed in this study.

並列關鍵字

Systemic lupus erythematosus ； kidney transplantation ； survival rate ； recurrence