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Master Thesis

Caractéristiques cliniques et évolution des patients atteints de néphropathie lupique traités par transplantation rénale : résultats de l'étude observationnelle multicentrique OKTALE

Abstract : Introduction: Lupus nephritis occurs in about 30% of patients with systemic lupus erythematosus (SLE), and 25% of them will progress to end stage renal disease. The aim of the study was to assess clinical characteristics and outcomes of kidney transplant recipients with lupus nephritis.
Methods: Patients with lupus nephritis were compared to a control group of kidney transplant recipients transplanted for other causes, matched for age, sex, date of transplant, and source of donor.
Results: Between 2000 and 2015, 189 recipients with lupus nephritis were included in a French multicenter cohort. The mean age of recipients was 42.6 years and 86.8% of them were female. Recipients with lupus nephritis presented a significantly greater proportion of anti human-leucocyte antigen class I antibodies and donor specific antibodies (51.7% versus 32.4%, p=0.005; 17.8% versus 4.5%, p=0.035, respectively), had a higher incidence of cardiovascular events than matched control recipients (37.0% versus 22.8%, p=0.002), and a higher incidence of hypertension (15.9% versus 7.9%, p=0.016). Patient and death-censored graft survival rates at one, five and ten years after kidney transplant were similar between recipients with lupus nephritis and controls. In a univariate analysis of the recipients with lupus nephritis the variables associated with cardiovascular events were age (46.33 years versus 40.97 years, p=0.0078), steroid dose at 12 months (8.6 mg versus 7.1 mg, p=0.0006) and proteinuria at 12 months, (0.175 g/g versus 0.102 g/g, p=0.03). Multivariate regression analysis of the recipients with lupus nephritis confirmed age (OR=1.033, 95% CI: 1.001-1.066, p=0.0454) and steroid dose at 12 months (OR=1.182, 95% CI: 1.000-1.398, p=0.050) as independent risk factors for cardiovascular events.
Conclusions: Survival outcomes of kidney transplants in recipients with lupus nephritis are similar to recipients with other causes, but cardiovascular diseases are widespread in this population and need to be closely monitored.
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Master Thesis
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Submitted on : Friday, November 29, 2019 - 11:34:59 AM
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Grégoire Ducoux. Caractéristiques cliniques et évolution des patients atteints de néphropathie lupique traités par transplantation rénale : résultats de l'étude observationnelle multicentrique OKTALE. Médecine humaine et pathologie. 2019. ⟨dumas-02386274⟩

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