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Recurrent lupus nephritis less frequent after kidney transplant
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CHICAGO — Lupus nephritis is recurring less frequently among patients with end-stage renal disease who undergo kidney transplant, possibly due to improved immunosuppression, according to data presented by Debendra N. Pattanaik, MBBS, MD, of the University of Tennessee Health Science Center.
“We have made a lot of progress in treating lupus nephritis in terms of the immunosuppressive regimen,” Pattanaik told attendees at the ACR/ARHP 2018 Annual Meeting. “However, up to 10% to 30% of patients end up in the end stages of the disease in spite of all the treatment. People in end-stage renal disease end up on dialysis and also undergo kidney transplant. Previous studies have shown that up to 50% of people who receive renal transplant end up getting a recurrence of the disease, but many of these were older studies. We have seen less recurrence in our patients in our clinical practice.”
To examine the recurrence of lupus nephritis among patients at the University of Tennessee Health Science Center, in Memphis, and determine whether the new post-transplant regimen has impacted the recurrence, Pattanaik and colleagues studied 38 patients treated with kidney transplant due to end-stage renal disease from lupus nephritis between 2006 and 2017. According to Pattanaik, these patients received a standard immunosuppressive regimen of prednisone, tacrolimus and mycophenolate mofetil, rather than prednisone, azathioprine and cyclosporine, which have been used in decades past.
Pattanaik and colleagues retrospectively reviewed the patients’ electronic medical records, as well as information from the United Network for Organ Sharing (UNOS) database. They recorded demographic, transplant and dialysis-related data, including kidney biopsy, graft loss and overall survival. The researchers then examined the association between recurrent lupus nephritis, survival and graft loss.
According to Pattanaik, patients included in the study spent a median of 4 years on previous dialysis, and 80% received hemodialysis while 31% underwent living donor transplant. Among the patients, 11% developed a biopsy-proven lupus nephritis recurrence, while 26% experienced graft loss or death during a median follow-up of 1,230 days. In the researchers’ unadjusted, proportional Cox regression model, patients with recurrent lupus nephritis showed a trend for increased risk for graft loss or death compared with recipients without recurrence.
“Many lupus nephritis patients have been waiting for transplant because the disease has to go into remission before that happens, and they will spend months or years in dialysis before they can get a transplant,” Pattanaik said. “Right now, the regimen they are using is also what we are using to treat lupus nephritis, so my next question is whether these patients can be transplanted earlier than the months and years they have been waiting.” – by Jason Laday
Disclosure: Pattanaik reports no relevant financial disclosures.
Reference:
Pattanaik DN. Abstract 711. Presented at ACR/ARHP Annual Meeting, Oct. 20-24, 2018; Chicago.