Lupus Nephritis Recurrence After Renal Transplant

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SAN FRANCISCO—Lupus nephritis recurrence (LNR) in renal transplant recipients with systemic lupus erythematosus (SLE) does not have an adverse impact on allograft or patient survival rates, according to the largest analysis of its kind to be reported.

The study showed that LNR was relatively benign compared with the initial condition that caused patients to progress to end-stage renal disease. Thus, LNR was not associated with graft loss or morbidity, said co-investigator Graciela Alarcon, MD, professor of medicine at the University of Alabama at Birmingham.

“If patients with lupus develop end stage renal disease, physicians should not be concerned about referring them for a renal transplant because their course is not going to be really any different. Many years ago, it was thought that these patients would not fare well but that is not what we have found,” Dr. Alarcon said.

She and her colleagues also found that LNR was more frequent in African-American patients and that the use of azathioprine protected against LNR and that tacrolimus was increased the risk of LNR.

Dr. Alarcon reported the findings here at the American College of Rheumatology annual meeting.

Her group studied 202 SLE patients who underwent 220 renal transplants at a large southeast tertiary academic medical center serving Alabama, southern Tennessee, western Georgia, Mississippi, and the Florida panhandle. Renal failure was attributed to lupus nephritis in all of them.

Of the 202 patients, 177 met study enrollment criteria. Their mean age was 35.6 years (range 13-82 years) and the mean disease duration was 11.2 years. In addition, 80% were female and 57% were African American.

LNR developed in 20 patients (11%) and allograft loss occurred in 39%. Death occurred in 20% of the 177 patients. The mean follow-up interval was 6.3 years for all patients and 4.2 years for those with LNR.  Overall, the researchers found that allograft loss was a strong predictor of death, but LNR was not.

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