Kidney Transplantation During Autoimmune Diseases M. Ounissi, E. Abderrahim, H. Hedri, M. Sfaxi, H. Fayala, S. Turki, H. Ben Maïz, T. Ben Abdallah, M. Chebil, and A. Kheder ABSTRACT Herein, we report the results of kidney transplantation in 9 of 376 patients who underwent kidney transplantation at our center between 1986 and 2007 because of chronic renal failure associated with autoimmune disease. Four of the 9 patients had systemic lupus erythematosus, 3 had Wegener granulomatosis, and 2 had Goodpasture syndrome. Six patients received organs from living donors, and 3 received cadaver organs. Infections were frequent and included cytomegalovirus and urinary tract infection in most cases. There was no difference in occurrence of metabolic and cardiovascular complications in our study patients compared with other transplant recipients. Incidence of allograft loss (n = 1) was similar to that in our entire transplantation population, with an overall rate of 2.9%. We conclude that kidney transplantation is a reasonable therapeutic option in patients with autoimmune disease with end-stage renal disease because of good graft and patient survival compared with kidney recipients without autoimmune diseases. K IDNEY TRANSPLANTATION remains the treat- ment of choice for end-stage renal disease (ESRD) even in patients with autoimmune disease. 1 In these pa- tients, it is recommended that the procedure be performed during a period of clinical and immunologic remission to avert potential risk of recurrence of underlying disease. 1 It has been well documented that both graft and patient survival in recipients who underwent transplantation be- cause of ESRD-related autoimmune disease are similar to those in other recipients. 2 We report our results in a single Tunisian center. PATIENTS AND METHODS Of 376 patients who underwent kidney transplantation at our center from 1986 to 2007, 9 had ESRD related to autoimmune disease, diagnosed after clinical examination. All patients had kidney involvement attributed to the underlying disease, based on renal biopsy findings. Clinical and biological data, and adverse events, relative to the outcome of both the underlying autoimmune disease and the graft, were recorded for each patient. Mortality and graft failure rates were calculated by dividing the number of events (death or graft loss) by total patient follow-up time. RESULTS Mean (SD; range) age of the 3 male and 6 female patients at transplantation was 25  6.8 (12–35) years. These 9 patients represented 2.2% of our total kidney transplanta- tion population. End-stage renal disease was attributed to systemic lupus erythematosus (SLE) in 4 patients, Wegener granulomatosis in 3 patients, and Goodpasture syndrome in 2 patients. The mean (range) time between diagnosis of autoimmune disease and initiation of renal replacement therapy was 34.7 (1–57) months. Duration of dialysis ther- apy was 41.3 (19 –78) months. Six patients received organs from living donors, and 3 from cadavers. At transplantation, there was no clinical or serologic indication of relapse of the underlying autoimmune disease. During cumulative follow-up of 35 years, only 1 graft was lost, at 49 months after transplantation, for an annual rate of 2.85% compared with 2.9% in recipients without auto- immune disease (P = NS). Annual mortality in our entire transplantation population was 2.8%, whereas no deaths occurred in kidney recipients with autoimmune disease. Patient data and outcomes are given in Table 1. DISCUSSION Renal involvement is common in patients with autoimmune diseases such as SLE, Wegener granulomatosis, and Good- From the Department of Internal Medicine A and Laboratory of Kidney Diseases (M.O., E.A., H.H., S.T., H.B.M., T.B.A., A.K.) and the Department of Urology (M.S., H.F., M.C.), Charles Nicolle Hospital, Tunis, Tunisia. Address reprint requests to Mondher Ounissi, MD, Depart- ment of Internal Medicine A, Charles Nicolle Hospital, Blvd du 9 Avril, 1006 BS, Tunis, Tunisia. E-mail: mejid66@yahoo.fr © 2009 by Elsevier Inc. All rights reserved. 0041-1345/09/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2009.07.019 Transplantation Proceedings, 41, 2781–2783 (2009) 2781