Premature cardiovascular disease in patients with systemic lupus erythematosus influences survival after renal transplantation

OBJECTIVE: To assess graft and patient survival as well as causes for graft loss and patient death after renal transplantation in patients with systemic lupus erythematosus (SLE). METHODS: Eighty-seven renal transplantations were performed in 77 patients with SLE from 1972 to 2005. Each recipient with SLE was matched (for date of transplant, age, donor source [living versus deceased], and sex) with 2 renal graft recipients who had non-SLE glomerulonephritis, and the SLE and non-SLE groups were compared with regard to graft survival and patient survival. RESULTS: The mean ± SD age of SLE patients at the time of transplantation was 37.4 ± 12.8 years, and the majority of SLE patients were female (80.5%). SLE patients were well matched to control transplant patients for date of transplant, age, and donor source (living versus deceased donor). The death-censored graft survival rate for SLE patients receiving transplants corresponded closely to that for the control groups; the 1-, 5-, and 10-year graft survival rates were 88%, 81%, and 71%, respectively, for SLE patients, and 91%, 83%, and 74%, respectively, for patients with non-SLE glomerulonephritis (P = 0.31). Patient survival differed significantly; the rates of survival for recipients with SLE were 94%, 83%, and 71% at 1, 5, and 10 years, respectively. The corresponding rates of patient survival in the non-SLE glomerulonephritis cohort were 96%, 92%, and 85% (P = 0.018). Cardiovascular events were the most prominent cause of death in SLE patients (66.7%, versus 39.5% in the control group; P = 0.03). CONCLUSION: Transplant patients with SLE have a graft survival rate that matches that of recipients with non-SLE glomerulonephritis. SLE patients who receive transplants have a lower survival rate than control patients. The excessive mortality in SLE is attributed to a greater number of cardiovascular deaths.