Outcome of patients with antineutrophil cytoplasmic autoantibody-associated vasculitis following cadaveric kidney transplantation

In this retrospective study, we report on the progress of eight patients with biopsy-proven systemic vasculitis following cadaveric renal transplantation. Extrarenal manifestations associated with antineutrophil cytoplasmic autoantibodies (ANCAs) were present in all but one case. All the patients were on cyclosporine A-based immunosuppression, and none of them had active disease at transplantation. The mean time from the last episode of vasculitis to transplantation was 46 months (range, 10 to 132 months). On the day of transplantation, all but one patient had detectable ANCAs, which ranged from 1:100 to 1:2,000 (perinuclear ANCAs [P-ANCAs], four patients; cytoplasmic ANCAs [C-ANCAs], three patients). There were three patients with Wegener's granulomatosis, none of whom relapsed. Of those patients with microscopic polyangiitis (P-ANCAs, three patients; C-ANCAs, two patients), only one presented with relapse episodes after transplantation; the episodes involved the lungs and the kidney graft, and were successfully treated by methylprednisolone pulses. This patient had the highest ANCA titer before (1:2,000) and after (up to 1:10,000) grafting, and received no immunosuppression prior to transplantation since vasculitis was diagnosed after she had developed end-stage renal failure. This study shows that a relapse of ANCA-associated vasculitis following successful cadaveric renal transplantation occurs infrequently in the cyclosporine A era (ie, 12%), despite the persistence of circulating ANCAs in these patients at the time of transplantation, and even afterward in some cases. (C) 1997 by the National Kidney Foundation, Inc.