Renal transplantation during autoimmune diseases is possible in the period of clinical and immunological remission of the disease. The results concerning the survival of the grafts and especially of the patients are much discussed and depend on the other manifestations of the causal disease. We report in a retrospective study a series of 9 patients: 3 men and 6 women having autoimmune diseases: systemic lupus erythematous (4cas), Good pasture syndrome (2 cases) and disease of Wegener (3 cases) old on average of 25, 11±6, 82 years (12-35) and transplanted renal after a median of 41, 29 months dialysis (19-78). They account for 2, 20% of the renal patients grafted since 18/6/1986 until the 31/12/2007. It is about a first transplantation for all the patients with three cadaver kidneys and six of donor living related. The average age of the donor was of 32, 88± 13, 25 years (21-54). Induction was containing thymoglobulin (6 cases) and the ant reject treatment associates corticoids, a anticalcineurine as soon as serum creatinin is with the lower part of 200 µmol/l (Tacrolimus in 3 cases and Cyclosporine in 6) and an inhibitor of the purine bases: Mycophenolate mofetil (8 cases) and Azathioprine (1 case). Three patients presented one acute tubular necrosis with delayed resumption from the renal function (2 corpses and 1 DVA) and two were treated for an acute rejection by thymoglobulin and bolus doe of methyl prednisolone with standardization of the renal function .Two patients present a chronic dysfunction of the graft proven histologically. No case of repetition of the initial nephropathy was announced. A hypertension was present among three patients. The infectious complications were present in 8 cases 5 urinary infections, an infection with CMV and Zona). A patient developed diabetes mellitus and another toxicity with the cyclosporine. Average serum creatinine with 6, 12 and 24 months was respectively of 92,16±14,9, 92,6±18,39 and 92±2,82 µmol / l. The median of survival of the patients is 14, 85 months (1-144) Survival with 1 and 2 years is comparable with that of all the others grafted of the kidney all nephropathies confused. Only one patient was transferred in hemodialysis because of a chronic dysfunction of the graft and deceased 8 months later by sudden death. A follow-up in the medium and long term will make it possible to have resulted statistically significant. Renal transplantation during autoimmune diseases is rare. The immunosuppression treatment is not different from the other nephropathies. Acute tubular necrosis and the acute rejection are frequent. The function of the graft is normal to 6, 12 and 24 months.
Volume : 6
Issue : 4
Pages : 61
Department of Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia