CLINICAL CHARACTERISTICS AND OUTCOMES OF KIDNEY TRANSPLANT RECIPIENTS WITH LUPUS NEPHRITIS: A SINGLE-CENTER LONGITUDINAL STUDY FROM THE UNITED ARAB EMIRATES

PV128a / #66 Poster Topic: AS15 - Lupus Nephritis-Clinical Background/Purpose Lupus nephritis (LN) is a common manifestation of systemic lupus erythematosus (SLE), with 10–30% of patients progressing to end-stage renal disease (ESRD) and requiring hemodialysis (HD).[1] Kidney transplantation (KT) is also a treatment option; however, long-term graft survival remains controversial.[2] The aim of this study is to evaluate the clinical characteristics of patients with LN who undergo KT, assess the disease course from SLE/LN diagnosis to KT, and estimate graft survival within a cohort from the United Arab Emirates (UAE). Methods Between April 2015 and April 2024, patients with LN who underwent KT were retrospectively studied at Cleveland Clinic Abu Dhabi. Data collected included sociodemographic information, clinical characteristics, laboratory investigations, lupus domain involvement, baseline KT variables, post-transplant complications, the timeline from SLE/LN diagnosis to KT, and immunosuppressive therapies. Descriptive statistics were used to analyze the data. Results Our database identified 37 patients with LN, of whom 26 were KT recipients, 4 were undergoing KT evaluation, and 7 were actively on the KT waitlist. The patients were predominately UAE nationals (94.59%), with 31 (83.78%) females and 6 (16.22%) males. The mean age of SLE diagnosis was 23.75 ± 11.80 years (mean ± SD), the mean age of LN diagnosis was 24.24 ± 9.13 years, and the mean age at HD initiation at 32.55 ± 11.43 years. The most common lupus domains involved were musculoskeletal (45.94%), seizures (18.92%), followed by oral ulcers (13.51%). The most common LN class was Class IV affecting 10 (27.03%) patients. Investigations revealed positive ANA in 23 patients (62.12%), positive anti-Smith in 7 (18.92%), a mean CRP of 26.58 ± 50.08 mg/L, a mean ESR of 43.59 ± 33.28 mm/hr, a mean C3 of 91.80 ± 38.21 mg/dL, and a mean C4 of 26.48 ± 14.63 mg/dL. Additionally, the mean dsDNA at clinic presentation and prior to KT were 23.59 ± 55.27 IU/mL and 11.89 ± 14.26 IU/mL, respectively (Table 1). Of those who underwent KT, 12 (46.15%) received a living donor kidney, while 10 (38.46%) received a deceased donor kidney. The mean age at KT was 32.35 ± 12.64 years, with an average follow-up of 91.77 ± 97.32 months. Post-transplant complications included re-transplantation in 3 (8.11%) patients, graft rejection in 7 (18.92%) patients, and death in 1 (2.7%) patient. Notably, there was an average time interval of 9.65 ± 6.66 years from LN diagnosis to KT, and 1.80 ± 7.59 years from HD initiation to KT. Regarding immunosuppressive medications, the majority of patients had a history of prednisone use, with 28 (75.68%) having used it previously and 31 (83.78%) currently using it. Additionally, mycophenolate mofetil was administered to 32 (86.49%) patients, tacrolimus to 24 (64.86%) patients, and hydroxychloroquine to 15 (40.54%) patients (Table 2). Table 1. Sociodemographic data, laboratory investigations, and lupus domains of KT patients with LN. Table 2. Baseline KT-related variables, post-transplant complications, diagnostic time intervals, and immunosuppressive therapies of KT patients with LN. Conclusions This study highlights the clinical profile and treatment outcomes of UAE patients with lupus nephritis undergoing kidney transplantation. The findings reveal significant time intervals from diagnosis to transplantation and initiation of hemodialysis. Despite high use of immunosuppressive medications, post-transplant complications, including graft rejection and the need for re-transplantation, remain notable. These results emphasize the importance of tailored management approaches and continued monitoring to enhance patient outcomes in this unique cohort.

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