*Purpose: Pediatric recipients of non renal abdominal organs may develop renal abnormalities of uncertain etiology. We describe for the first time de novo lupus-like glomerulonephritis in patients with non renal abdominal organ transplants.

*Methods: We surveyed 690 patients with isolated pediatric liver transplants (OLTx) and 96 pediatric intestine-inclusive transplants (IITx) and found 8 patients with features of lupus glomerulonephritis. OLTx patients underwent kidney biopsy at a mean of 10 years after transplant, while IITx patients’ biopsies was a mean of 3 years after transplant. We scored the biopsies by the 2017 ISN/RPS classification for lupus nephritis.

*Results: Twelve patients from January 1993- May 2018, had clinical renal abnormalities and underwent native kidney biopsy. Six of 8 patients with OLTx (0.8% of all OLTx) and two of four patients with IITx (2.1% of all IITx) manifested lupus-like changes in their kidney biopsies. Results are summarized in the included table. Biopsy findings included class III and IV lupus glomerulonephritis with mesangial proliferative features. All 8 manifested “full house” immunostaining in glomeruli. Clinically 63% presented with nephrotic syndrome and 25% with extrarenal manifestations of lupus. Lupus related serologies include dsDNA (n=3), ANA (n=2), beta-2-glycoprotein IgA (n=1), cardiolipin IgG (n=2), low C3 (n=2) and low C4 (n=2). At biopsy eGFR ranged from 66 – 202 mL/min/1.73 m². Current eGFR ranged from 28-120 mL/min/1.73 m², a mean decrement of 30 in all patients (p= 0.11). One of 8 progressed to dialysis.

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*Conclusions: Patients with OLTx and IITx may manifest clinical and histological lupus-like changes of new onset de novo glomerulonephritis. The presence of a de novo lupus-like glomerulonephritis should be considered in patients with renal abnormalities in non renal abdominal organ transplants.

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