POS-718 IMPACT OF INITIAL STEROID RESPONSE ON TRANSPLANT OUTCOMES IN CHILDREN WITH STEROID RESISTANT NEPHROTIC SYNDROME

Abstract

Limited data suggest that children with SRNS who were initially steroid sensitive (ISS) have an increased risk of recurrence post transplantation. ISS may be a proxy for those with circulating factor disease. There are no data on risk of transplant loss stratified by ISS. Children who received a kidney transplant between 2000 and 2019 for SRNS in 7 paediatric centres were included. Clinical data were gathered from chart reviews and transplant data were provided from ANZDATA following ethics approval. Transplant survival was estimated using the Kaplan-Meier estimator with Cox modelling used to explore predictors of survival. There were 60 children who were transplanted for SRNS, 31 (51%) male, average age at transplant 11 years (SD 4) and 39 (65%) Caucasian. At presentation, 19/60 (32%) were steroid sensitive before becoming steroid resistant. Of the ISS group, 18/19 (95%) had recurrence post-transplant, compared to 17/41 (41%) of those always steroid resistant (p=0.001). The median time to recurrence was 3 days (inter quartile range 0-12 days), with no difference between the groups (p=0.9). Full remission after recurrence was achieved in 9/18 (50%) of the ISS group and 7/17 (42%) in the always steroid resistant group (p=0.64). Overall, 5-year transplant survival was 57% (95%CI 38-85%) in the ISS group, compared to 78% (95%CI 64-95%) in the always steroid resistant group (p=0.07) (Figure 1). Initial steroid sensitivity is strongly associated with SRNS recurrence. Transplant survival for children with SRNS is poor with a non-significant trend to poorer outcomes for those with initial steroid sensitivity. Further research involving other cohorts is needed to assess if initial steroid sensitivity is associated with poorer graft outcomes.