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Make the grade for Wegener's granulomatosis after kidney transplantation

Antineutrophil cytoplasmic antibodies-associated vasculitis (AAV) is a well-described cause of multiple organ involvement including rapidly progressive pauci-immune crescentic glomerulonephritis. Kidney transplantation (KTx) is considered the treatment of choice in patients with end-stage renal dise...

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Autores principales: Schewior, Lioba, Dragun, Duska, Rudolph, Birgit, Schaeffner, Elke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421184/
https://www.ncbi.nlm.nih.gov/pubmed/25983992
http://dx.doi.org/10.1093/ndtplus/sfp006
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author Schewior, Lioba
Dragun, Duska
Rudolph, Birgit
Schaeffner, Elke
author_facet Schewior, Lioba
Dragun, Duska
Rudolph, Birgit
Schaeffner, Elke
author_sort Schewior, Lioba
collection PubMed
description Antineutrophil cytoplasmic antibodies-associated vasculitis (AAV) is a well-described cause of multiple organ involvement including rapidly progressive pauci-immune crescentic glomerulonephritis. Kidney transplantation (KTx) is considered the treatment of choice in patients with end-stage renal disease (ESRD) due to AAV. Patient and graft survival in AAV after KTx is favourable and comparable with other non-diabetic causes of ESRD. While relapse of AAV is high in dialysis patients (up to 50%), it decreases after KTx (8.6–22.2%). Yet, relapse may occur at any time after KTx and transplant involvement has been documented in at least 25 cases. Therapeutic guidelines for the management of AAV after KTx do not exist and clinical management is a controversial discussion. We present two unusual cases of young males with smouldering AAV who recently underwent KTx at our hospital. Case 1 experienced repeated relapses after KTx and was finally successfully treated with rituximab. Case 2 received rituximab pre-emptively before living kidney donation and remained free of flairs. Prompted by theses two cases, we reviewed the literature focusing on the right point of time for transplantation, risk assessment, role of antineutrophil cytoplasmic antibodies, clinical presentation of flairs and immunosuppression in smouldering Wegener's granulomatosis (WG) and in relapse, including individualized treatment with rituximab.
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spelling pubmed-44211842015-05-15 Make the grade for Wegener's granulomatosis after kidney transplantation Schewior, Lioba Dragun, Duska Rudolph, Birgit Schaeffner, Elke NDT Plus In-Depth Clinical Review Antineutrophil cytoplasmic antibodies-associated vasculitis (AAV) is a well-described cause of multiple organ involvement including rapidly progressive pauci-immune crescentic glomerulonephritis. Kidney transplantation (KTx) is considered the treatment of choice in patients with end-stage renal disease (ESRD) due to AAV. Patient and graft survival in AAV after KTx is favourable and comparable with other non-diabetic causes of ESRD. While relapse of AAV is high in dialysis patients (up to 50%), it decreases after KTx (8.6–22.2%). Yet, relapse may occur at any time after KTx and transplant involvement has been documented in at least 25 cases. Therapeutic guidelines for the management of AAV after KTx do not exist and clinical management is a controversial discussion. We present two unusual cases of young males with smouldering AAV who recently underwent KTx at our hospital. Case 1 experienced repeated relapses after KTx and was finally successfully treated with rituximab. Case 2 received rituximab pre-emptively before living kidney donation and remained free of flairs. Prompted by theses two cases, we reviewed the literature focusing on the right point of time for transplantation, risk assessment, role of antineutrophil cytoplasmic antibodies, clinical presentation of flairs and immunosuppression in smouldering Wegener's granulomatosis (WG) and in relapse, including individualized treatment with rituximab. Oxford University Press 2009-06 2009-02-02 /pmc/articles/PMC4421184/ /pubmed/25983992 http://dx.doi.org/10.1093/ndtplus/sfp006 Text en © The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle In-Depth Clinical Review
Schewior, Lioba
Dragun, Duska
Rudolph, Birgit
Schaeffner, Elke
Make the grade for Wegener's granulomatosis after kidney transplantation
title Make the grade for Wegener's granulomatosis after kidney transplantation
title_full Make the grade for Wegener's granulomatosis after kidney transplantation
title_fullStr Make the grade for Wegener's granulomatosis after kidney transplantation
title_full_unstemmed Make the grade for Wegener's granulomatosis after kidney transplantation
title_short Make the grade for Wegener's granulomatosis after kidney transplantation
title_sort make the grade for wegener's granulomatosis after kidney transplantation
topic In-Depth Clinical Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421184/
https://www.ncbi.nlm.nih.gov/pubmed/25983992
http://dx.doi.org/10.1093/ndtplus/sfp006
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