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CHICAGO -- Recurrent lupus nephritis, a complication for patients with systemic lupus erythematosus (SLE) with end-stage renal disease who undergo kidney transplant, has been declining thanks to improvements in immunosuppression, a University of Tennessee researcher told a press conference Monday at the annual meeting here.

Debenda Pattanaik, MBBS, MD, a rheumatologist at the University of Tennessee Health Science Center in Memphis, said, "In our practice, we are seeing less recurrence, and patients are doing better compared to what has been reported in the literature."

He said previous studies have shown a "variable" rate of recurrent lupus nephritis in transplant patients ranging from 3% to 46%.

His of 38 patients shows a recurrence rate of 11%.

The Tennessee patients received transplants between 2016 and 2017. Patient electronic medical records were reviewed retrospectively along with information from the United Network for Organ Sharing database. Researchers noted demographic information and transplant and dialysis-related information, including kidney biopsy, graft loss, and survival.

Pattanaik attributed this dramatic drop in recurrence rates to improved immunosuppressive regimens in recent decades.

At present, the standard regimen, introduced in the late 1990s, includes prednisone, tacrolimus, and mycophenolate mofetil. Previously, patients received a regimen, introduced in the mid-1960s, prednisone, azathioprine, and cyclosporine.

Pattanaik noted mycophenolate mofetil may be an important factor because it is used to treat proliferative lupus nephritis.

Press conference moderator Jason Liebowitz, MD, a second year rheumatology fellow at Johns Hopkins University in Baltimore, questioned whether there might have been undetected recurrences in the Memphis group.

Pattanaik said it is possible because patients in earlier research underwent routine "protocol biopsies," while his patients were biopsied if they displayed symptoms.

The mean age of patients in the Tennessee study was 41, 89% were women, and 89% were African Americans.

Four of the 38 patients (11%) had biopsy-proven lupus nephritis recurrences. Patients had spent a median of 4 years on dialysis.

Ten patients (26%) had graft loss or death during a mean follow-up of 1,230 days.

Pattanaik stressed that graft loss secondary to recurrence of lupus ought to be less of a concern when rheumatologists and nephrologists are recommending renal transplants for their patients.

He said rheumatologists should be activists for this patient population, which typically is young with many potential years ahead. He said patients with SLE with end-stage renal disease ought to be considered as good candidates for renal transplantation as patients with diabetes and hypertension. "They can have as good an outcome," he said.

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