WIP 50 - Kidney Transplant Outcomes in Pediatric Patients with Lupus Nephritis

Monika M. Sullivan, Stanford University, Los Altos, CA, United States; Abanti Chaudhuri, Stanford University School of Medicine, Stanford, CA, United States; Kristen Cunanan, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Up to 30% of patients with lupus develop end stage kidney disease (ESKD), with even higher rates of ESKD in childhood onset systemic lupus erythematosus (cSLE). Adults with lupus nephritis have similar kidney transplant outcomes to patients with other causes of ESKD, but patients with cSLE are reported to have poorer outcomes. Prior studies evaluating allograft survival and mortality in cSLE have shown discrepant results. It remains unclear whether patients with cSLE have worse transplant outcomes than their non-cSLE counterparts, and most importantly, why these differences may exist.

Objective: (1) Compare allograft survival and overall survival outcomes among transplant recipients with diagnoses of cSLE, non-cSLE glomerulonephritis, and non-glomerular kidney disease.
(2) Identify factors associated with worse kidney transplant outcomes in patients with cSLE.

Design/Methods: This is a retrospective cohort study using the Improving Renal Outcomes Collaborative (IROC) database, which includes over 3000 pediatric kidney transplant recipients. Patients ages 0 to 21 years old who underwent kidney transplantation from 2016-2023 are included and categorized into three groups by primary diagnosis: cSLE, non-cSLE glomerulonephritis, and non-glomerular kidney disease. Associations between each disease group and 1) allograft survival and 2) overall survival will be evaluated. Exposures of interest in the cSLE group (transplant recipient and donor characteristics, post-transplant immunosuppression, lab results, blood pressure control, and adherence barriers) will be assessed to identify factors highly associated with the primary outcome of allograft survival and secondary outcomes of 1) overall survival 2) rejection 3) post-transplant infection and 4) post-transplant donor specific antibodies. Kaplan-Meier and Cox regression models will be used to estimate associations. The parent IROC study has IRB approval (IRB-43469), for which Stanford Children’s Health is a participating center. Next steps include data cleaning and analyses, with expected completion by 1/31/25.