Background/Purpose: Evidence of kidney disease occurs in up to one half of patients with SLE, and approximately 10% of the patients with lupus nephritis (LN) will go on to develop end stage renal disease (ESKD). Kidney transplantation is a safe and effective treatment for ESKD secondary to LN; and is associated with improved patient survival. of ESKD has been described as associated with a decrease in extrarenal manifestations of SLE following kidney transplantation when patients are placed on anti-rejection immunosuppressive therapy. Hydroxychloroquine (HCQ) has often been described as a medication with significant benefits and improving overall survival in patients with SLE regardless of their disease activity. With this in mind, we sought to explore outcomes of continuing HCQ following renal transplant in patients with LN.

Methods: In this retrospective, observational cohort study, we explore various outcomes in patients with SLE and kidney transplant status receiving hydroxychloroquine following transplant compared to those with SLE and kidney transplant status who did not receive HCQ following transplant. We utilized the TrinetX database, which includes electronic health records from over 80 different global healthcare organizations. We created two groups: the first cohort included patients with SLE, kidney transplant status and HCQ (2855 patients), and the second cohort included patients SLE, kidney transplant status not on HCQ (4627 patients). The outcomes investigated were cerebral infarction, MACE risk, deceased, and ESKD (occurring within 3 years after transplant and receiving HCQ vs not receiving it “index event”), using International Classification of Diseases, Tenth Revision (ICD-10) codes. We excluded patients with these outcomes prior to undergoing kidney transplant and/or starting the medication.

Results: After propensity score matching, it was noted that between the cohorts, there was no difference between each group for developing cerebral infarction (2.757% vs 2.709 %), with a risk ratio of 1.018, p-value of 0.919 with a 95% CI (0.726,1.426). There was a reduced risk in all-cause mortality in the first (HCQ) cohort (3.271% vs 5.452%), with a risk ratio of 0.6, p-value of 0.0002 with a 95% CI (0.458,0.786). For MACE risk, there was no difference between groups (5.075% vs 4.588%), with a risk ratio of 1.106, p-value of 0.4366 with a 95% CI (0.858, 1.426). Lastly, the HCQ cohort had increased risk of developing ESKD following kidney transplant (40.015% vs 16.918%) with a risk ratio of 1.49, p-value < 0.0001 with a 95% CI (1.323, 1.678).

Conclusion: In SLE patients status post kidney transplantation, hydroxychloroquine (HCQ) use was associated with a significantly reduced risk of all-cause mortality, suggesting a potential survival benefit. However, HCQ use was also linked to a substantially increased risk of progression to end-stage kidney disease. No significant differences were observed in the risk of cerebral infarction or major adverse cardiovascular events (MACE). These findings suggest a complex and context-dependent risk–benefit profile for HCQ in the post-transplant setting, emphasizing the need for individualized therapeutic strategies and further prospective investigation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-of-continuing-hydroxychloroquine-following-renal-transplant-in-patients-with-lupus-nephritis-a-retrospective-cohort-study-using-the-trinetx-database/