Session Information
Date: Tuesday, November 10, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: To study the utility of lupus serology as a predictor for kidney graft outcome in: a) a systematic review (SR) of the literature and b) a lupus cohort.
Methods: For the SR, a literature search in Medline and Embase (inception-2014) was performed to identify the articles reporting on the serology at RT and on the outcome of RT. Included studies were critically appraised using the Newcastle Ottawa Scale (NOS).
Patients who underwent RT in the identified. RT outcomes included: a) nonfunctional graft requiring dialysis ≤ 3 weeks, b) graft failure requiring permanent dialysis after 3 weeks, c) graft survival not requiring dialysis d) death. The patients were grouped into graft failure and survival. The duration of graft failure was defined as the time between RT and subsequent 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:
The literature search identified 539 references, excluding 119 duplicates. Of the 539, 534 were not relevant to the research question. 5 studies in addition to our lupus cohort data (n= 77 patients) were included in the SR. The majority of the grafts survived to at least 1 year regardless of whether the serology was positive or negative pre transplant which is consistent with the results of our lupus cohort (Table 1). The quality assessment of the studies using the NOS revealed limitations in the domains of outcome and selection due to small sample size and a short follow up period.
32 of 1783 patients in our lupus cohort had a RT. 2 patients had a nonfunctional graft, 5 patients had graft failure (2 patients had failure <5 years and 3 ≥5 years) and 25 patients had graft survival (11 had survival ≥5 years). 1 year prior to RT, 40% of the graft failures had positive serology compared to 52% in the graft survival (Table 2). Both failure and survival groups demonstrated no clinical disease activity at 1 year prior to RT. The time to graft failure (n=5) was 9.2 ± 6.77 years. In the failure group, 2 patients died by 12.1 ± 1.0 years, 2 patients are still alive and 1 was lost to follow-up. In the graft survival group, 5 patients died by 7.1 ± 5.6 years and 1 patient was lost of follow-up. Cause of death was ischemic heart disease in 3 patients, sepsis in 2 patients and unknown in 1 patient.
Table 1: Survival of the graft in patients with positive and negative serology at RT
|
Seropositive patients n=33 |
Seronegative patients n=38 |
|||||||||
|
Failure at 6 months |
Failure at 1 year |
Failure at 6 months |
Failure at 1 year |
Failure at 5 years |
||||||
|
Author |
Yes |
No |
Yes |
No |
Yes |
No |
Yes |
No |
Yes |
No |
|
Yap 2015 |
0 |
15 |
0 |
15 |
0 |
13 |
0 |
0 |
1 |
11 |
|
Dong 2005 |
0 |
3 |
0 |
2 |
0 |
10 |
0 |
9 |
1 |
3 |
|
Rivera 1990 |
NA |
NA |
NA |
NA |
0 |
4 |
0 |
4 |
0 |
3 |
|
Amend 1977 |
2 |
6 |
2 |
6 |
0 |
2 |
0 |
2 |
NA |
NA |
|
Bitker 1993 |
0 |
4 |
0 |
4 |
NA |
NA |
2 |
4 |
NA |
NA |
|
Goss 1991 |
0 |
3 |
1 |
2 |
0 |
9 |
0 |
9 |
2 |
2 |
|
Total |
2 |
31 |
3 |
29 |
0 |
38 |
2 |
28 |
4 |
19 |
Table 2.Characteristics of graft failure and survival patients in our lupus cohort
|
Graft Failure n=5 |
Graft survival n=25 |
Total Grafts n=30 |
|
|
Sex (F) |
100% |
84% |
86.7% |
|
Age at lupus diagnosis (yr) |
27.14 ± 9.66 |
22.28 ± 7.43 |
23.09 ± 7.87 |
|
Age at RT (yr) |
33.79 ± 14.01 |
39.14 ± 8.83 |
38.25 ± 9.79 |
|
Lupus duration at 1st clinic visit (yr) |
6.21 ± 4.19 |
7.60 ± 8.94 |
7.37 ± 8.30 |
|
Lupus duration at RT (yr) |
6.65 ± 4.82 |
16.86 ± 8.22 |
15.16 ± 8.61 |
|
DNA +ve in 1 year prior |
1/5 |
6/24 (NA n=1) |
7/29 |
|
Low complements in 1 year prior |
2/5 |
13/25 |
15/30 |
|
DNA +veand low C3/C4 in 1 yr prior |
1/5 |
4/23 (NA n=2) |
5/28 |
|
DNA +ve and/or low C3/C4 in 1 yr post RT |
3/4 NA n=1 |
12/25 |
15/29 |
|
AMS-(serology) 1 yr prior to RT |
4.90 ± 2.54 |
3.75 ± 4.59 |
3.90 ± 4.36 |
|
SDI at RT |
4.00 ± 0.82 |
4.48 ± 2.43 |
4.41 ± 2.28 |
|
Months on dialysis prior to RT |
33.43 ± 17.54 |
56.25 ± 45.55 |
51.86 ± 42.34 |
|
Source of allograft (Cadaver or Living) |
2/5 Cadaver 1/5 Living 2/5 Unknown |
11/25 Cadaver 13/25 Living 1/25 Unknown |
13/30 Cadaver 14/30 Living 3/25 Unknown |
Conclusion: The results of this SR found that the persistence of serological abnormalities at the time of RT was not associated with graft failure. These results are consistent with the results of our lupus cohort.
To cite this abstract in AMA style:
Yap K, Urowitz M, Mahood Q, Medina-Rosas J, Sabapathy A, Lawson D, Su J, Gladman D, Touma Z. The Utility of Lupus Serology in Predicting Outcomes of Renal Transplantation in Lupus Patients: Systematic Review and Analysis of a Large Lupus Cohort [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-utility-of-lupus-serology-in-predicting-outcomes-of-renal-transplantation-in-lupus-patients-systematic-review-and-analysis-of-a-large-lupus-cohort/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-utility-of-lupus-serology-in-predicting-outcomes-of-renal-transplantation-in-lupus-patients-systematic-review-and-analysis-of-a-large-lupus-cohort/