dsDNA, Will You Scare My New Kidney Away? SLE Serology and Implications for Transplant Rejection

Patients with systemic lupus erythematosus (SLE) with renal dysfunction may be considered for renal transplantation. However, one may wonder if the serological status of such patients could affect the success and long-term outcome of renal transplantation? Yap et al (University of Toronto) presented an abstract at the CRA today entitled "The Utility of Serology in Predicting Outcome of RenalTransplantation in Lupus Patients: Systematic Review and Analysis of the Toronto Lupus Cohort" (abstract 126).

The purpose of this review was to study the utilityof SLE serology as a predictor for kidney graft outcome. They undertook a systematic literature review and studied this issue in the Toronto Lupus Cohort (TLC). A literature search was performed to identify articles that reported on serology (positive dsDNA and low C3 and C4 levels) one year prior to renal transplantation, and the outcome of these renal transplants. Using the TLC, patients who underwent renal transplantation were identified and grouped into graft failure and graft survival. Serology (dsDNA positivity as well as low C3 and C4 levels) was studied in both of these groups.

The literature review identified 5 studies with information on serological status (77 patients analyzed). The studies revealed that the majority of grafts survived to at least 1 year regardless of serology results pre-transplant. Similar results were seen in the TLC group: 32/1783 patients had a renal transplant and among these, 2 patients had a non-functional graft, 5 had graft failure and 25 had graft survival. Half of the patients in the renal transplantation group had positive serology prior to the time of transplantation. 40% of graft failure patients had positive serology 1 year prior to renal transplantation compared to 52% of those with graft survival. The group concluded that persistence of serological abnormalities at the time of renal transplantation was not associated with graft failure.

Limitations of this study include small sample size, as well as limited time of follow-up. In addition, information such as degree of elevation of dsDNA, reduction in C3 and C4, and other aspects of SLE activity at the time of serological measurements and their impact on transplant survival, were not specified.

This abstract is helpful in that it demonstrates that serological activity in SLE patients prior to transplant does not predict outcome of renal graft. This may be helpful in situations where qualification for transplant could be jeopardized by the presence of serological markers of SLE activity. However, this study looked at serological markers 1 year prior to the time of renal transplant, rather than immediately before transplantation. In addition, other markers of SLE activity (i.e. active urinary sediment, other symptoms of SLE flare) were not commented on.

Would the serological status of your patient influence your decision to transplant?

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