Systemic lupus erythematosus after renal transplantation: patient and graft survival and disease activity

Article Abstract:

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of connective tissue that affects the skin, joints, kidneys, nervous system, and mucous membranes. SLE may be complicated by end-stage renal failure, or advanced kidney failure. In the past, patients with SLE complicated by disorders of several organ systems died before progression to uremia, a toxic condition resulting from the retention of nitrogen-containing wastes in the blood. High doses of corticosteroid agents have controlled various complications, but have been ineffective in preventing kidney-associated death and disease. Dialysis, the artificial filtration of the blood, is used to manage SLE patients with kidney disease, but kidney transplantation can permit the patient to resume a full and active life. Studies suggest that the survival of the transplanted kidney may be as good for patients with SLE as recipients without SLE. The outcome and disease activity of 28 patients with SLE and advanced kidney disease, who received kidney transplants, were assessed. The survival rates of the kidney graft were 68 percent at one year, and 54 percent at five years. The survival rate of the patients at one and five years was 87 percent. SLE disease activity did not influence the survival of the graft, and decreased after transplantation. Only one patient experienced recurrence of lupus nephritis, the inflammation of the kidney associated with SLE. These findings suggest that SLE patients with advance kidney disease are excellent candidates for kidney transplantation, which is associated with decreased SLE disease activity and rare recurrence of lupus nephritis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Systemic lupus erythematosus

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Reversal of left ventricular dysfunction after renal transplantation

Article Abstract:

Four cases are described of patients with end-stage renal disease, or kidney failure, and non-ischemic heart failure, or heart failure resulting from a cause other than ischemia, an insufficient blood supply. These patients were not initially considered as suitable candidates for kidney transplant, because each had impaired function of the left ventricle of the heart. The left ventricular end-diastolic pressure, or pressure in the left ventricle during the contraction phase of the heart cycle, was elevated at 20 to 30 millimeters of mercury (mm Hg). Their left ventricular ejection fraction, or percentage of blood emptied from the left ventricle during contraction, was depressed at 20 to 35 percent. However, the patients underwent kidney transplant, and their cardiac function significantly improved within six to 14 days after surgery. The ejection fraction increased from 43 to 69 percent. These results show that a certain group of patients with kidney failure should not be denied kidney transplants because of complications associated with heart failure. It is concluded that patients with end-stage renal disease and nonischemic heart failure have a reversible heart disease, and they should be considered for kidney transplant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Heart failure

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Complete sustained response of a refractory, post-transplantation, large B-cell lymphoma to an anti-CD22 immunotoxin

Article Abstract:

Treatment with anti-CD22 immunotoxin appears to have been effective in a patient who developed lymph cancer four months after a kidney transplant. An immunotoxin is a chemotherapy linked to an antibody that specifically targets cancer cells. Treatment with acyclovir and prednisone was not successful. Tests on the cancer tissue cells revealed the presence of CD19 through CD22 antigens and evidence of the Epstein-Barr virus. Cross-sectional scans performed 12 months after three sessions of immunotoxin therapy directed against the CD22 antigen revealed no evidence of disease.

Health aspects, Lymphomas, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, Antibody-toxin conjugates, Immunotoxins

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