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Recurrent Lupus Nephritis in Kidney Transplant Recipients With SLE Can Be Predicted: Presented at Renal Week 2009

By Kristina Rebelo

SAN DIEGO -- October 30, 2009 -- Recurrent lupus nephritis (RLN) in kidney transplant recipients with systemic lupus erythematosus (SLE) can be predicted by race/ethnicity, gender, and age, according to a study released here at the American Society of Nephrology (ASN) Renal Week 2009.

Using the United Network for Organ Sharing (UNOS) files, the estimated prevalence of RLN in kidney transplant recipients between 1987 and 2006 was examined. Researchers found 167 cases with RLN. They compared these against 1,770 controls with rejection, and 4,913 "other" controls without recurrence or rejection.

"This study illustrates the most important baseline risk factors," said Gabriel Contreras, MD, a physician in private practice in Miami, Florida, during a news conference on October 29. "The strongest risk factors for developing lupus nephritis in their transplanted kidney were African American race, female gender, and age less than 33 years."

Specifically, the study reported results for the period prevalence of RLN at 2.44%. By logistic regression analysis, Black non-Hispanics race-ethnicity (odds ratio [OR] 1.71; 95% confidence interval [CI], 1.25-2.34); female gender (OR 1.69; 95% CI, 1.05-2.75); and age <33 years old (OR 1.39; 95% CI, 1.02-1.91) were independently associated with the development of RLN. One hundred fifty-six (93.4%), 1,517 (85.7%), and 923 (19.1%) recipients in the RLN, rejection, and "others" groups respectively lost their allograft.

By proportional hazard regression analyses, RLN (HR 4.09; 95% CI, 3.41-4.92 vs others group) was independently associated with increased risk for allograft failure adjusting for rejection and other important covariates. The attributable risk for allograft failure of RLN was 7%.

Dr. Contreras noted that a limitation of the study was that the prevalence of RLN might be underestimated. "But having lupus should not keep patients from seeking transplant if they need one," he said.

The study said that 27 (16.2%), 313 (17.7%), and 527 (10.7%) recipients in the RLN, rejection, and "others" groups died, respectively (P < .0001 for trend).

"The type of kidney transplant before or after starting dialysis did not affect the risk; living versus deceased donors also had no effect on the recipient's risk of developing lupus nephritis," said Dr. Contreras. "The timing from the transplantation to RLN can occur as early as the first week to year 16, with most events within 10 years."

Funding for this study was provided by Health Resources and Services Administration.

[Presentation title: Recurrence of Lupus Nephritis Following Kidney Transplantation. Abstract SA-PO3076]

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