*Purpose: Hydroxychloroquine (HCQ) use leads to better patient and renal survival in patients with lupus nephritis (LN). Whether the clinical benefits of HCQ extends to lupus nephritis patients, following kidney transplantation is unknown. We hypothesized HCQ use in kidney transplant recipients with LN as the cause of end-stage renal disease (ESRD) is associated with improved patient and graft survival post-transplant.

*Methods: All adult kidney transplant recipients at our institute between Jan 1994- Dec 2016 with LN as the cause of ESRD were included in this study. The cohort was divided based on HCQ use. Primary outcomes were patient death and allograft failure (defined as re-transplant or return to dialysis).

*Results: : Among the 205 kidney transplant recipients with LN as cause of ESRD, 70 (34%) were on HCQ post-transplant and 135 (66%) were not on HCQ post-transplant. Mean age was 42 years in both groups. 83% were females in HCQ users vs 75% in HCQ non-users. 21% and 22% of patients were from non-white race in HCQ users and non-users respectively. Of the 205 patients, 55 patient died during a follow-up time of 15 years. Patient survival was better in in HCQ users at 81% compared to 69% in HCQ non-users at 15 years post-transplant and this was statistically significant (p<0.0001) (Figure 1A). Graft survival was also better in HCQ users (61%) compared to non-users (48%) at 15 years post transplant which was statistically significant (p=0.03) (Figure 1B). On univariable analysis, HCQ non-use, age <45 years, non-white race were predictors of patient mortality. On multivariable analysis, we found HCQ users had 0.5 times lower odds of patient death (p=0.03), non-white race had 2-fold higher risk of patient death (p=0.009) (Table 1).

*Conclusions: HCQ use after kidney transplantation in patients with LN as cause of ESRD is associated with better patient and graft survival at 15 years following kidney transplantation. Patients from non-white race have significantly higher mortality compared to white patients.

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