Background: In the early 1990s, intake of slimming pills containing Aristolochic Acids (AA) led to a rapidly progressive kidney failure secondary to an interstitial renal fibrosis with extensive tubular atrophy. AA are nephrotoxins and a significant proportion of patients developed urothelial carcinoma. The aim of this study was to assess the outcome of patients with AA nephropathy (AAN) after kidney transplantation.

Methods: We performed a case-control study in patients with AAN who underwent kidney transplantation. Patients’ characteristics and outcomes were compared to a control group of patients with interstitial chronic nephropathy matched for gender and age at transplantation.

Results: Twenty patients were transplanted since 1992 for AAN. All had a history of AA consumption and a histological image on kidney biopsy or nephrectomy characteristic of AAN. Nineteen were female. All but one were Caucasian. Mean age at diagnosis was 45 ± 2 years (39 ± 2 in controls, p= ns). Time on dialysis was 19 ± 4 months (28 ± 3 in controls, p= ns). Time from diagnosis to transplantation was significantly shorter in AAN patients (5 ± 0.7 vs 11 ± 1 years). Mean age at transplantation was 50 ± 3 years (49 ± 2 in controls, p= ns). Mean time of follow-up was 13 ± 1 years. Immunosuppressive therapy was comparable in both groups. Biopsy-proven acute rejection was 20% in both groups. Seven patients presented with urothelial carcinomas of the upper-tract; two of them with additional bladder urothelial carcinomas. Of these two patients, one required radical cystectomy. In the control group, none suffered from urological complications. Cardiovascular complications were comparable in both groups. Patient survival was 100% in AAN patients compared to 100, 92 and 92% in the control group (p=ns) at 5, 10 and 15 years respectively after transplantation. Graft survival at 5, 10, and 15 years was 95, 83, and 75% in the AAN group compared to 100, 92, and 92% in the control group (p=ns).

Conclusion: AAN leads rapidly to end-stage renal disease requiring transplantation. Although 35% of patients presented urothelial carcinomas of the upper-tract and bladder, patients survival is excellent and graft survival is not affected.

« Back to 2013 American Transplant Congress