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Transplantation in ANCA Vasculitis — SCE Rheumatology MCQ

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HardVasculitisTransplantation in ANCA VasculitisSCE Rheumatology

A 45-year-old woman developed end-stage kidney disease due to PR3-ANCA-associated vasculitis. She has received dialysis for 14 months and has had no clinical or laboratory evidence of active vasculitis for 8 months, although PR3-ANCA remains detectable at a stable titre. Which statement best describes her suitability for kidney transplantation?

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Correct answer: C — Transplantation is appropriate after at least 6 months of clinical remission; persistent ANCA alone should not delay it, but post-transplant surveillance is required

Kidney transplantation is an appropriate renal replacement strategy in ANCA-associated vasculitis once the disease has been in clinical remission for at least 6 months. This patient has been clinically inactive for 8 months and is therefore eligible for transplant assessment. Persistent PR3-ANCA positivity is not, by itself, a reason to delay transplantation, although it may justify closer surveillance for recurrence. Relapse after transplantation is uncommon rather than inevitable and can affect either the graft or extrarenal organs. Therefore, A and C incorrectly make ANCA negativity mandatory, while B incorrectly treats AAV as a contraindication. There is no requirement to use a living donor, so E is also incorrect. Transplantation treats kidney failure but does not cure the underlying systemic vasculitis.

Reference: Rauen T et al. KDIGO 2021 guideline glomerulonephritis—focus on ANCA-associated vasculitides and anti-glomerular basement membrane glomerulonephritis, transplantation section, 2021. https://pubmed.ncbi.nlm.nih.gov/27765007/