AB0443 RENAL TRANSPLANTATION IN LUPUS NEPHRITIS. LONG-TERM FOLLOW-UP. STUDY FROM A SINGLE REFERRAL CENTER.
Authors: L. Sanchez-Bilbao, M. De Cos-Gómez, J. C. Ruiz-San Millán, M. A. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2020)

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 assess a ) clinical features, b ) renal transplantation as replacement therapy, c ) SLE flares after transplantation Methods: 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 1 and 1.1. TABLE 1. Demographic baseline characteristics and clinical manifestations of patients with renal transplantation due to LN. DEMOGRAPHIC PARAMETERS Sex, n (%) 7 ♂ / 16 ♀ (30.4%/69.06%) Age at SLE diagnosis (years), mean ± SD 26.37±12.70 Age at renal transplantation, mean ± SD 39.80±11.27 SLE RELATED DATA Systemic symptoms 12.0 (52.17 ) Fever, n (%) 8.0 (34.78) Weight loss, n (%) 3.0 (30.0) Asthenia, n (%) 3.0 (30.0) Articular affection 12.0 (52.17 ) Joint swelling, n (%) 9.0 (39.13) Arthralgia, n (%) 3.0 (13.04) Skin affection 13.0 (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 1 and 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 DATA Renal involvement 16.0 (69.56 ) Hematological involvement 13.0 (56.52 ) Anemia, n (%) 6.0 (26.10) Leukopenia, n (%) 5.0 (21.73) Thrombocytopenia, n (%) 2.0 (8.70) Pericarditis 2.0 (8.70 ) Nervous system 6.0 (26.10 ) Peripheral, n (%) 1.0 (4.34) Central 4.0 (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