Background/Purpose:

Recurrence of lupus nephritis in the graft is a concern in lupus patients with end stage renal disease who undergo renal transplantation. The recurrence of lupus nephritis has been variable among different studies depending on the patient characteristics, immunosuppressive regimens and indications of renal biopsy. One of the major change is the use of posttransplant immunosuppressive regimen consisting of tacrolimus and mycophenolate mofetil instead of cyclosporine and azathioprine in addition to prednisone. Many of the previous studies reported the recurrence of lupus nephritis where cyclosporine and azathioprine were used as posttransplant regimen. We investigated the recurrence of lupus nephritis among our patients to see if the new posttransplant regimen has impacted the recurrence.

Methods:

All recipients, who were transplanted between 2006-2017 in our center, with end stage renal disease secondary to lupus nephritis have been included in the study (n=38). Medical records of all 38 patients were reviewed retrospectively in the electronic medical record and information from the United Network for Organ Sharing Network (UNOS) were also reviewed retrospectively. Demographic information, transplant and dialysis related information have been recorded including kidney biopsy, graft loss and survival. The result of the indication biopsies has also been recorded. Association between recurrent lupus nephritis and survival and graft loss were examined using survival models.

Results:

The overall mean± SD age at baseline was 42±13 years; 89% were female; 89% were African-American; the previous time on dialysis was median of 4 years (IQR: 2-8 years), 80% received hemodialysis and 31% received living donor transplantation in the cohort. All our patients received the standard immunosuppressive regimen consisting of prednisone, tacrolimus and mycophenolate mofetil. Four (11%) of the 38 patients had biopsy proven lupus nephritis recurrence. Total of 10 patients (26%) had graft loss or death during the median follow up time was 1,230 days (IQR: 460-2,227 days). Patient with recurrence showed trend for increased risk for graft loss or death (Hazard Ratio:3.14, 95%Confidence Interval: 0.65-15.24) compared to the recipient without recurrence in our unadjusted proportional Cox regression model.

Conclusion:

Recurrence rate of lupus nephritis in our patient population is much lower compared to previous data from different immunosuppressive era. Patient with recurrent disease showed trend for increased risk for graft loss or death. The current standard of posttransplant immunosuppressive regimen may have played role in lower relapse rate.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/recurrence-of-lupus-nephritis-in-renal-transplant-recipients/