Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Lupus nephritis (LN) occurs in 50-75% of adults with SLE and up to 20% of LN patients may advance to end stage renal disease over a 10-year period. The aims of this study were to provide an overview of the characteristics of lupus patients with renal transplantation (RT) followed in the Lupus Clinic between 1970-2012, and to determine the survival of the graft and patients after RT.
Methods:
Patients with lupus have been followed prospectively at the lupus clinic since 1970. Patients attend the clinic at 2-6 month intervals and the standard protocol includes: complete history, physical and laboratory evaluation. Patients who underwent RT were identified from the database. RT outcomes included: a) nonfunctional graft requiring dialysis within ≤3 weeks, b) graft failure requiring permanent dialysis after 3 weeks, c) graft survival not requiring dialysis and d) death.
Descriptive analysis was used to study the characteristics of all patients. We grouped the patients into graft failure and graft survival. The duration of graft failure was defined as the time between RT and subsequent permanent dialysis. The duration of graft survival was defined as the time between RT and recipient death or the end of the study with functioning graft.
Results:
25 (20 F) of 1645 patients followed in the lupus cohort and of 780 with renal involvement were identified with RT. 10 (40%) were Caucasian, 7 (28%) Black, 4 (16%) Asian and 4 (16%) others. The age at diagnosis of lupus and at transplant was 30.7±13.8 and 38.1±9.6 years respectively. Lupus duration at RT was 13.3±7.6 years. 2 (8%) patients had a nonfunctional graft, 4 (16%) patients had graft failure (1 patient had failure <5 years and 3 ≥5 years) and 19 (76%) patients had graft survival (8 had S ≥5 years) (Table 1). Patients with graft survival were older and had longer lupus duration compared to patients with failure at the time of RT. 25% of the graft failures had positive lupus serology compared to 47% in the graft survival 1 year prior to RT.
The time to graft failure (n=4) was 5.75±4.99y. In the failure group 3 patients died by 6±5.19 years and one patient is still alive. In the graft survival group 3 patients died by 5.6±4.6 years and one patient was lost of follow-up. Cause of death was not related to renal disease in 2patients and unknown in one patient.
Conclusion:
25 of 780 lupus nephritis patients followed at the Lupus Clinic underwent RT. The persistence of serological abnormalities at the time of RT was not associated with graft failure.
Table 1. Characteristics if graft failure and graft survival patients.
|
|
Graft Failure N=4 |
Graft survival N=19 |
|
Sex |
F 75% |
F 84% |
|
Age at lupus diagnosis |
25.4±7.3 |
24.4±8.3 |
|
Age at transplant |
29.8±9.1 |
40.0±9.5 |
|
Lupus duration at 1st clinic visit |
5.9±4.0 |
7.2±7.8 |
|
4.5±2.1 |
15.5±7.1 |
|
|
Ethnicity Caucasian Black Asian Others |
1 1 2 0 |
7 6 2 4 |
|
Positive DNA in 1 year prior |
1/4 |
5/18 |
|
Low complements in 1 year prior |
1/4 |
9/19 |
|
Positive DNA and/or low complements in 1 year prior |
1/4 |
9/19 |
|
Positive DNA and/or low complements in 1 year after transplant |
2/3 |
8/19 |
|
SDI at transplant |
4.0±0 (n=4) |
4.6±1.9 (n=17) |
|
Time (duration) on dialysis prior to transplant |
3.9±2.4 (n=4) |
5.8±5.6 (n=6) |
Disclosure:
Z. Touma,
None;
M. B. Urowitz,
None;
D. Ibanez,
None;
D. D. Gladman,
None.
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