Abstract
Background
Renal transplantation (RTx) is the modality of choice for ESRD due to ANCA associated vasculitis (AAV). The significance of ANCA positivity (ANCA+) at the time of RTx on recurrent disease is controversial.
Methods
We evaluated clinical outcomes and predictors of vasculitis relapse in sixteen transplanted AAV patients who were ANCA+ at RTx at a single University Medical Center. Allograft function, vasculitis relapse, and predictors of vasculitis relapse were assessed using descriptive statistics and logistic regression analysis.
Results
Our cohort had a median age of 64 years, 88 % Caucasians, 63 % males, 50 % PR3+. All patients were in remission at the time of RTx. Twelve received induction therapy and all were on mycophenolate mofetil, prednisone and tacrolimus. The mean (SD) serum creatinine was 1.2 (0.3) mg/dl at 1 year and 1.8 (1.7) mg/dl at last follow up. Six developed vasculitis relapse at post-transplant. All relapses were treated with escalation in immunosuppression. One non-compliant patient suffered graft loss while the remaining patients achieved remission. In adjusted logistic regression analysis, PR3 ANCA+ patients were two times (OR 2.19, p = 0.71) more likely to experience a relapse compared to MPO ANCA+ patients.
Conclusions
This study demonstrates that PR3 ANCA+ patients may be more likely to experience relapse post-transplant. Further investigation of the predictors of vasculitis relapse among AAV patients who are ANCA+ at the time of RTx needs to be pursued.
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Duvuru Geetha, M.D.: served as a consultant to Genentech and received honoraria for educational training purposes from Genentech. Scott M Lee: none. Shivani Shah: none. M Hafizur Rahman: none.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helinski declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Institutional Research Board as an Exempt application.
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Informed consent requirement from participants was waived by Institutional Review Board.
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Geetha, D., Lee, S.M., Shah, S. et al. Relevance of ANCA positivity at the time of renal transplantation in ANCA associated vasculitis. J Nephrol 30, 147–153 (2017). https://doi.org/10.1007/s40620-015-0253-6
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DOI: https://doi.org/10.1007/s40620-015-0253-6