Abstract: SA-PO523

Frequent Histologic Recurrence of Lupus Nephritis after Kidney Transplantation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Gonzalez Suarez, M. Lourdes, Mayo Clinic, Rochester, Minnesota, United States
  • Kattah, Andrea G., Mayo Clinic, Rochester, Minnesota, United States
  • Cosio, Fernando G., Mayo Clinic, Rochester, Minnesota, United States
  • Cornell, Lynn D., Mayo Clinic, Rochester, Minnesota, United States
  • Alexander, Mariam P., Mayo Clinic, Rochester, Minnesota, United States
Background

Recurrent lupus nephritis (RLN) has been described as uncommon after kidney transplantation (KTx), though reported incidences vary from 0 to 44%. RLN may be subclinical and therefore missed in some patients (pts) without protocol kidney biopsies (KBx). We aimed to assess the incidence and characteristics of histologic subclinical recurrence of lupus nephritis (SRLN) by protocol KBx.

Methods

A multicenter review of medical records of pts with lupus nephritis (LN) who underwent a KTx (January 1998-December 2012) was conducted. Baseline demographics, proteinuria, hematuria, LN class and KBx findings, graft and patient survival by Kaplan Meir were reviewed. A cohort of 60 pts with polycystic kidney disease (PKD) that had received a KTx in the same period was randomly selected as controls.

Results

We found 51 pts with LN who received a KTx in the participating centers. Population was predominantly female (66%); median age at time of KTx was 37±7. RLN, including SRLN and clinical RLN (CRLN) was seen in 29 pts (57%). Median time to any recurrence was 33.1 months. KBx was clinically indicated due to rising creatinine and/or BK viremia in 18 of 29 pts, and due to suspicion of RLN in 2 pts who had systemic flares. SRLN was found in 10 pts (34%). One of SRLN pts had concomitant acute rejection; 4 CRLN pts also had rejection. Among SRLN pts, hematuria was seen in 4 and mean proteinuria was 295 mg/24h (range 45-1433) vs. 9 of 18 CRLN pts had hematuria, and mean proteinuria was 1098 mg/24hr (range 100-4000) (p=0.1). Two CRLN pts had low complements (one had low C3 and C4, the other one only low C4); the rest of the CLRN pts and SRLN pts had normal complements. Graft loss occurred in 3 SRLN pts and 4 CRLN pts (30% vs. 22% accordingly). No difference was found in graft survival among SRLN, CRLN and PKD groups. Mean time to graft loss was 10.3±1.2 years in SRLN, and 7.6±0.7 years in CRLN (p=0.8). Patient survival was similar among SRLN, CRLN and PKD groups, with a median of 10 years (until time of follow up) (p=0.7).

Conclusion

RLN was found in more than half of our study population. There was clinical suspicion of recurrence in 2 cases. SRLN was found on 1/3 of protocol KBx. Our study showed that SRLN is common and can remain subclinical overtime, though did not impact graft loss or survival as compared to controls in this study population.