FRI0253 RENAL TRANSPLANTATION IN LUPUS NEPHRITISVS NON-AUTOIMMUNE TRANSPLANTATION. LONG TERM FOLLOW-UP. STUDY FROM A SINGLE TERTIARY CENTER
Authors: Lara Sánchez Bilbao, Iñigo González-Mazón, Marina de Cos-Gómez, Belén Atienza-Mateo, José Luis Martín-Varillas, Monica Calderón-Goercke, D. Prieto-Peña, Juan Carlos Ruiz-San Millán, Miguel Á. González-Gay, Ricardo Blanco
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> 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. <h3>Objectives</h3> 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). <h3>Methods</h3> We study two groups of patients with first renal transplantation: <b>a)</b> LN and <b>b)</b> control group with PCKD. All these patients were transplanted in a single reference University Hospital. The main outcome variables were <b>a)</b> graft and patient survival up to 20 years and <b>b)</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 chi<sup>2</sup>/Fisher's exact test for qualitative variables. <h3>Results</h3> 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 <b>TABLE-1</b>. 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 <b>(Figures 1 and 2).</b> <h3>Conclusion</h3> 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. <sup>*p&lt;0.05</sup> <h3>Disclosure of Interests</h3> Lara Sánchez Bilbao: None declared, Iñigo González-Mazón: None declared, Marina de Cos-Gómez: None declared, Belén Atienza-Mateo: None declared, José Luis Martín-Varillas: None declared, Monica Calderón-Goercke: None declared, D. Prieto-Peña: None declared, Juan Carlos Ruiz-San Millán: None declared, Miguel Á. González-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