Skip to main content

Advertisement

SpringerLink
Log in

Relevance of ANCA positivity at the time of renal transplantation in ANCA associated vasculitis

  • Original Article
  • Published:
Journal of Nephrology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Booth AD, Pusey CD, Jayne DR (2004) Renal vasculitis—an update in 2004. Nephrol Dial Transpl 19(8):1964–1968

    Article  Google Scholar 

  2. de Lind van Wijngaarden RA, Hauer HA, Wolterbeek R, Jayne DR, Gaskin G, Rasmussen N et al (2006) Clinical and histologic determinants of renal outcome in ANCA-associated vasculitis: a prospective analysis of 100 patients with severe renal involvement. J Am Soc Nephrol 17(8):2264–2274

  3. Weidner S, Geuss S, Hafezi-Rachti S, Wonka A, Rupprecht HD (2004) ANCA-associated vasculitis with renal involvement: an outcome analysis. Nephrol Dial Transpl 19(6):1403–1411

    Article  Google Scholar 

  4. Allen A, Pusey C, Gaskin G (1998) Outcome of renal replacement therapy in antineutrophil cytoplasmic antibody-associated systemic vasculitis. J Am Soc Nephrol 9(7):1258–1263

    CAS  PubMed  Google Scholar 

  5. Hruskova Z, Geetha D, Tesar V (2015) Renal transplantation in anti-neutrophil cytoplasmic antibody-associated vasculitis. Nephrol Dial Transpl 30(Suppl 1):i159–i163

    Google Scholar 

  6. Tang W, Bose B, McDonald SP, Hawley CM, Badve SV, Boudville N et al (2013) The outcomes of patients with ESRD and ANCA-associated vasculitis in Australia and New Zealand. Clin J Am Soc Nephrol 8(5):773–780

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hruskova Z, Stel VS, Jayne D, Aasarod K, De Meester J, Ekstrand A et al (2015) Characteristics and outcomes of granulomatosis with polyangiitis (Wegener) and microscopic polyangiitis requiring renal replacement therapy: results from the European renal association-european dialysis and transplant association registry. Am J Kidney Dis 66(4):613–620

    Article  PubMed  Google Scholar 

  8. Geetha D, Eirin A, True K, Valentina Irazabal M, Specks U, Seo P et al (2011) Renal transplantation in antineutrophil cytoplasmic antibody-associated vasculitis: a multicenter experience. Transplantation 91(12):1370–1375

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gera M, Griffin MD, Specks U, Leung N, Stegall MD, Fervenza FC (2007) Recurrence of ANCA-associated vasculitis following renal transplantation in the modern era of immunosupression. Kidney Int 71(12):1296–1301

    Article  CAS  PubMed  Google Scholar 

  10. Moroni G, Torri A, Gallelli B, Quaglini S, Pozzi C, Banfi G et al (2007) The long-term prognosis of renal transplant in patients with systemic vasculitis. Am J Transpl 7(9):2133–2139

    Article  CAS  Google Scholar 

  11. Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH et al (2013) KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis. Am J Kidney Dis 62(3):403–441

    Article  PubMed  Google Scholar 

  12. Knoll G, Cockfield S, Blydt-Hansen T, Baran D, Kiberd B, Landsberg D et al (2005) Canadian society of transplantation: consensus guidelines on eligibility for kidney transplantation. CMAJ 173(10):S1–S25

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sanders JS, Huitma MG, Kallenberg CG, Stegeman CA (2006) Prediction of relapses in PR3-ANCA-associated vasculitis by assessing responses of ANCA titres to treatment. Rheumatology (Oxford) 45(6):724–729

    Article  CAS  Google Scholar 

  14. Nachman PH, Segelmark M, Westman K, Hogan SL, Satterly KK, Jennette JC et al (1999) Recurrent ANCA-associated small vessel vasculitis after transplantation: a pooled analysis. Kidney Int 56(4):1544–1550

    Article  CAS  PubMed  Google Scholar 

  15. Marco H, Mirapeix E, Arcos E, Comas J, Ara J, Gil-Vernet S et al (2013) Long-term outcome of antineutrophil cytoplasmic antibody-associated small vessel vasculitis after renal transplantation. Clin Transplant 27(3):338–347

    Article  PubMed  Google Scholar 

  16. Little MA, Hassan B, Jacques S, Game D, Salisbury E, Courtney AE et al (2009) Renal transplantation in systemic vasculitis: when is it safe? Nephrol Dial Transpl 24(10):3219–3225

    Article  Google Scholar 

  17. Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL et al (1994) Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 37(2):187–192

    Article  CAS  PubMed  Google Scholar 

  18. Leavitt RY, Fauci AS, Bloch DA, Michel BA, Hunder GG, Arend WP et al (1990) The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum 33(8):1101–1107

    Article  CAS  PubMed  Google Scholar 

  19. Briganti EM, Russ GR, McNeil JJ, Atkins RC, Chadban SJ (2002) Risk of renal allograft loss from recurrent glomerulonephritis. N Engl J Med 347(2):103–109

    Article  PubMed  Google Scholar 

  20. Moran S, Little MA (2014) Renal transplantation in antineutrophil cytoplasmic antibody-associated vasculitis. Curr Opin Rheumatol 26(1):37–41

    Article  CAS  PubMed  Google Scholar 

  21. Walsh M, Flossmann O, Berden A, Westman K, Hoglund P, Stegeman C et al (2012) Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum 64(2):542–548

    Article  CAS  PubMed  Google Scholar 

  22. Reaich D, Cooper N, Main J (1994) Rapid catastrophic onset of Wegener’s granulomatosis in a renal transplant. Nephron 67(3):354–357

    Article  CAS  PubMed  Google Scholar 

  23. Fan SL, Lewis KE, Ball E, Dodd S, Raftery MJ, Yaqoob MM (2001) Recurrence of Wegener’s granulomatosis 13 years after renal transplantation. Am J Kidney Dis 38(6):E32

    Article  CAS  PubMed  Google Scholar 

  24. Gomez-Puerta JA, Bosch X (2009) Anti-neutrophil cytoplasmic antibody pathogenesis in small-vessel vasculitis: an update. Am J Pathol 175(5):1790–1798

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Finkielman JD, Lee AS, Hummel AM, Viss MA, Jacob GL, Homburger HA et al (2007) ANCA are detectable in nearly all patients with active severe Wegener’s granulomatosis. Am J Med 120(7):643 e9–e14

  26. Tomasson G, Grayson PC, Mahr AD, Lavalley M, Merkel PA (2012) Value of ANCA measurements during remission to predict a relapse of ANCA-associated vasculitis—a meta-analysis. Rheumatology (Oxford) 51(1):100–109

    Article  CAS  Google Scholar 

  27. Nowack R, Grab I, Flores-Suarez LF, Schnulle P, Yard B, van der Woude FJ (2001) ANCA titres, even of IgG subclasses, and soluble CD14 fail to predict relapses in patients with ANCA-associated vasculitis. Nephrol Dial Transpl 16(8):1631–1637

    Article  CAS  Google Scholar 

  28. Fussner LA, Specks U (2015) Can antineutrophil cytoplasmic antibody levels be used to inform treatment of pauci-immune vasculitis? Curr Opin Rheumatol 27(3):231–240

    Article  CAS  PubMed  Google Scholar 

  29. Rostaing L, Modesto A, Oksman F, Cisterne JM, Le Mao G, Durand D (1997) Outcome of patients with antineutrophil cytoplasmic autoantibody-associated vasculitis following cadaveric kidney transplantation. Am J Kidney Dis 29(1):96–102

    Article  CAS  PubMed  Google Scholar 

  30. Deegens JK, Artz MA, Hoitsma AJ, Wetzels JF (2003) Outcome of renal transplantation in patients with pauci-immune small vessel vasculitis or anti-GBM disease. Clin Nephrol 59(1):1–9

    Article  CAS  PubMed  Google Scholar 

  31. Cao Y, Tian Z, Li W, Ma L, Yu Y, Ren W (2014) Predictors of treatment resistance and relapse in Chinese patients with antineutrophil cytoplasmic antibody-associated disease. J Rheumatol 41(5):916–922

    Article  PubMed  Google Scholar 

  32. Hogan SL, Falk RJ, Chin H, Cai J, Jennette CE, Jennette JC et al (2005) Predictors of relapse and treatment resistance in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis. Ann Intern Med 143(9):621–631

    Article  PubMed  Google Scholar 

  33. Lyons PA, Rayner TF, Trivedi S, Holle JU, Watts RA, Jayne DR et al (2012) Genetically distinct subsets within ANCA-associated vasculitis. N Engl J Med 367(3):214–223

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Duvuru Geetha & Shivani Shah

  2. Baylor University and Baylor College of Medicine’s Baylor² Medical Track, Waco, TX, USA

    Scott M. Lee

  3. Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Hafizur M. Rahman

Authors
  1. Duvuru Geetha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Scott M. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shivani Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hafizur M. Rahman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Duvuru Geetha.

Ethics declarations

Conflict of interest

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.

Ethical approval

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.

Informed consent

Informed consent requirement from participants was waived by Institutional Review Board.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40620-015-0253-6

Keywords

Search

Navigation