FRI0253 RENAL TRANSPLANTATION IN LUPUS NEPHRITISVS NON-AUTOIMMUNE TRANSPLANTATION. LONG TERM FOLLOW-UP. STUDY FROM A SINGLE TERTIARY CENTER

Abstract

Background Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE), affecting up to 30-40% of patients. Unfortunately, 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 patients with first renal transplantation due to LN our aim was to assess a) long-term post-transplant survival and, b) comparison of post-transplant survival with a control group due to a non-autoimmune nephropathy, the polycystic kidney disease (PCKD). Methods We study two groups of patients with first renal transplantation: a) LN and b) control group with PCKD. All these patients were transplanted in a single reference University Hospital. The main outcome variables were a) graft and patient survival up to 20 years and b) evolution of renal function (serum creatinine and proteinuria) in the first 5 years of follow-up. Cumulative survival rates after transplantation were estimated by the Kaplan-Meier method and compared between groups using the log-rank test. Mann-Whitney test was used to compare quantitative variables and chi2/Fisher’s exact test for qualitative variables. Results We included a total of 53 patients with renal transplant; a) LN group (n=21), b) PCKD group (n=32). No significant differences at baseline were observed between the 2 groups regarding sex and cardiovascular risk factors. Significant differences were found in terms of age at kidney transplantation, with a mean of 39.80±11.27 years in LN group and 46.59±5.01 years in the PCKD group (p=0.004). Renal biopsy had been performed in 16 patients with LN: type II LN (25%), type III (25%) and type IV (50%), (according to the World Health Organization and International Society of Nephrology/Renal Pathology Society classification). From 48 patients (of 53) in which a renal biopsy was performed during the first-year post-transplant, rejection was found in 21 patients (43.7%) without significant differences between the 2 groups (p=0.444). The evolution of serum creatinine and proteinuria after renal transplantation is shown in TABLE-1. Regarding serum creatinine, significant differences were found in creatinine levels only at the 6th month post-transplant (p=0.032) with no differences in the following measurements. In LN group, 3 patients (14.3%) developed a lupus flare: 2 cases presented as extrarenal disease and only 1 case with histological recurrence in the graft. No significant differences were found in terms of patient or graft survival between the two groups in 20 years of follow-up (Figures 1 and 2). Conclusion Despite concerns about LN recurrence after renal transplantation, data obtained in our sample indicate that this procedure as a safe alternative therapy for ESRD in this population and can provide a long-term survival. *p Disclosure of Interests Lara Sanchez Bilbao: None declared, Inigo Gonzalez-Mazon: None declared, Marina de Cos-Gomez: None declared, Belen Atienza-Mateo: None declared, Jose Luis Martin-Varillas: None declared, Monica Calderon-Goercke: None declared, D. Prieto-Pena: None declared, Juan Carlos Ruiz-San Millan: None declared, Miguel A. Gonzalez-Gay: None declared, Ricardo Blanco Grant/research support from: Abbvie, MSD, and Roche, Consultant for: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen