Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 3:15pm-3:27pm
*Purpose: Lupus nephritis (LN) progresses to ESRD in <10% of patients (pts) and may recur in the allograft. The recurrence rates of LN vary from 0-44% with variable impact on allograft survival. We aimed to evaluate recurrent LN (RLN) in a 3 site study using histology as evidence of recurrence.
*Methods: 215 pts with ESKD due to LN (American College of Rheumatology criteria for LN) and 1st transplants at any Mayo Clinic site from 1996-2018 were included. All post transplant biopsies (bx) with IF and EM were evaluated to determine for RLN. RLN was classified as clinical- CRLN (proteinuria/hematuria) or only histological- HRLN (no urinary changes).
*Results: In this cohort of 215 with mean age of 42.4±12.9, 80% (172) were women, 27.4% (59) were African-American and 10.2% (22) were Hispanic, with median follow up time of 66 months(range 1-199). Of the 189 patients who had a bx post-transplant, 105 had biopsies with IF/EM of which 38 (36%) were diagnosed with RLN-19/38(50%) were classified as HRLN and the rest had clinical features at the time of bx (CRLN). Despite recurrence, neither the CRLN , HRLN or non RLN biopsy groups had significant differences in allograft survival at 5 yrs (91.0% vs. 87.0% vs. 89.6%,p=0.26), although HRLN occurred earlier (Figure 1). There was higher microscopic hematuria in CRLN compared to initial HRLN alone (21.1% vs. 1.5% p<0.01) but not more proteinuria (48.7% vs. 40.9%, p=0.28) at last follow up. Subsequent bx, where available, showed that the pathology changed over time - however Class V remained the same (Figure 1). The majority of biopsies were Class II in recurrence. There were no identified risk factors for recurrent disease including age, ethnicity, immunosuppression, age of LN diagnosis, transplant site, WHO classification of native LN.
*Conclusions: We conclude that the early protocol biopsy with IF/EM will help to diagnose histological recurrence. The classification of RLN might change through the repeated biopsies. Histological or Clinical recurrence has little influence on the survival of the allograft.
To cite this abstract in AMA style:Bentall A, Jiqiu W, Kattah A, Suarez MLGonzalez, Cosio FG, Mai M, Khamash H, Stegall MD, Amer H, Cornell LD, Fervenza F, Alexander MP. Recurrent Lupus Post Kidney Transplantation- The Histological and Clinical Characteristics [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/recurrent-lupus-post-kidney-transplantation-the-histological-and-clinical-characteristics/. Accessed September 21, 2021.
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