Abstract
BackgroundRecurrence of lupus nephritis in the graft is a concern in lupus patients with end-stage renal disease undergoing renal transplantation. The recurrence of lupus nephritis has been variable among different studies depending on the patient characteristics, immunosuppressive regimen, and indications of renal biopsy. Therefore, we investigated the recurrence of lupus nephritis among our patients to see if the new post-transplant regimen has impacted the recurrence.MethodsWe collected data on all recipients with end-stage renal disease secondary to lupus nephritis, who received renal transplants between 2006-2017 in our center. Patient demographics, transplant, and dialysis-related information have been recorded including kidney biopsy, graft loss, and survival were recorded. An association between recurrent lupus nephritis with survival and/or graft loss was examined using survival models.ResultsThe overall mean±SD age at baseline was 42±13 years; 89% were female; 89% were African American; the previous time on dialysis was a median of 4 years (IQR: 2-8 years), 81% received hemodialysis and 31% received living donor transplantation in the cohort. Our patients received the standard immunosuppressive regimen consisting of prednisone, tacrolimus, and mycophenolate mofetil. Four (10.5%) of the 38 patients had biopsy-proven lupus nephritis recurrence. A total of 10 patients (26%) had graft loss or died during the median follow-up time of 1,230 days (IQR: 460-2,227 days). Recurrence of lupus nephritis showed a trend for increased risk of graft loss or patient 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.ConclusionThe recurrence rate of lupus nephritis in our patient population is much lower compared to past studies from different immunosuppressive eras. Patients with recurrent lupus nephritis showed an increased risk of graft loss or death.
Highlights
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by autoantibody formation with heterogeneous clinical manifestations [1]
The overall mean±standard deviation (SD) age at baseline was 42±13 years; 89% were female; 89% were African American; the previous time on dialysis was a median of 4 years (IQR: 2-8 years), 81% received hemodialysis and 31% received living donor transplantation in the cohort
Our patients received the standard immunosuppressive regimen consisting of prednisone, tacrolimus, and mycophenolate mofetil
Summary
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by autoantibody formation with heterogeneous clinical manifestations [1]. The five-year risk for developing endstage renal disease (ESRD) is 10-70% among lupus nephritis patients [3]. Renal transplantation is the treatment of choice for patients with lupus nephritis who develop ESRD [4]. The recurrence rate in the allograft can vary from 0-54% depending on various factors such as patient population, indication for renal biopsy, immunosuppressive regimen, and histological assessment [10,11,12,13,14,15,16,17,18]. Recurrence of lupus nephritis in the graft is a concern in lupus patients with end-stage renal disease undergoing renal transplantation. The recurrence of lupus nephritis has been variable among different studies depending on the patient characteristics, immunosuppressive regimen, and indications of renal biopsy. We investigated the recurrence of lupus nephritis among our patients to see if the new post-transplant regimen has impacted the recurrence
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