AB0443 RENAL TRANSPLANTATION IN LUPUS NEPHRITIS. LONG-TERM FOLLOW-UP. STUDY FROM A SINGLE REFERRAL CENTER.

Abstract

Background:Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE). Approximately 10-20% of LN develop end stage renal disease (ESRD) and need replacement therapy. Renal transplantation may be a good option. However, concerns about LN recurrence after renal transplantation have been reported.Objectives:In a series of 23 patients with first renal transplantation due to LN our aim was to assessa) clinical features,b) renal transplantation as replacement therapy,c) SLE flares after transplantationMethods:Observational study of unselected all consecutive patients studied in a single reference University Hospital with: a) diagnosis of SLE by ACR/SLICC 2012 criteria.b) diagnosis of NL by performing biopsy (according to the World Health Organization and International Society of Nephrology/Renal Pathology Society classification),c) first renal transplant. Cumulative survival rates after transplantation were estimated by the Kaplan-Meier method.Results:We studied 23 (16 women/7 men) patients with first renal transplantation due to LN; mean age at SLE diagnosis of 26.37±12.70 years and mean age at kidney transplantation of 39.80±11.27 years. Mean follow-up of 12.18±9.02 years. Demographic baseline characteristics and clinical manifestations of these patients are shown in TABLE 1and 1.1.TABLE 1.Demographic baseline characteristics and clinical manifestations of patients with renal transplantation due to LN.DEMOGRAPHIC PARAMETERSSex, n (%)7 ♂ / 16 ♀ (30.4%/69.06%)Age at SLE diagnosis (years), mean ± SD26.37±12.70Age at renal transplantation, mean ± SD39.80±11.27SLE RELATED DATASystemic symptoms12.0 (52.17) Fever, n (%)8.0 (34.78) Weight loss, n (%)3.0 (30.0) Asthenia, n (%)3.0 (30.0)Articular affection12.0 (52.17) Joint swelling, n (%)9.0 (39.13) Arthralgia, n (%)3.0 (13.04)Skin affection13.0 (56.52) Malar erythema, n (%)2.0 (8.6) Discoid lupus, n (%)0.0 (0.0) Photosensitivity, n (%)3.0 (13.04) Ulcers, n (%)5.0 (21.73) Alopecia, n (%)3.0 (13.04) Raynaud, n (%)1.0 (4.34)The main clinical manifestations at diagnosis were articular (n= 12; 52.17%) and cutaneous (n=13; 56.52%). On the other hand, 16 patients (69.6%) presented impaired renal function at diagnosis. In the other 7 patients (30.4%), this manifestation appeared with a delay of diagnosis from the onset of symptoms of 13.17±7.73 years.Renal biopsy had been performed in 21 patients with LN: type II LN (n=2; 9.1%), type III (n=8; 36.4%), type IV (n=9; 40.9%) and type V (n=2; 9.1%).Patient and graft survival function after transplantation is represented in Figure 1and 2.Figure 1.Regarding lupus flares after transplantation, 3 patients (13.04 %) developed a lupus flare: 2 cases presented as extrarenal disease (one of them was a pneumonitis and the other one was a cutaneous and articular flare) and only 1 case with histological recurrence in the graft (Mean follow-up 15.00±9.84 years).Conclusion:Renal transplantation is a safe alternative therapy for ESRD in this population and can provide a long-term survival. However, it is very important to consider the occurrence of flares even in the long-term post-transplant.Figures 1 and 2.Figure 2.Table 2.1.1.SLE RELATED DATARenal involvement16.0 (69.56)Hematological involvement13.0 (56.52) Anemia, n (%)6.0 (26.10) Leukopenia, n (%)5.0 (21.73) Thrombocytopenia, n (%)2.0 (8.70)Pericarditis2.0 (8.70)Nervous system6.0 (26.10) Peripheral, n (%)1.0 (4.34) Central4.0 (17.40)Disclosure of Interests:Lara Sanchez-Bilbao Grant/research support from: Pfizer, Marina de Cos-Gómez: None declared, Juan Carlos Ruiz-San Millán: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD