Objective To investigate the efficacy and long-term prognosis of umbilical cord derived mesenchymal stem cells (UC-MSC) transplantation in treatment of refractory lupus nephritis (LN).

Methods Ninety-two patients with refractory LN treated with UC-MSC were selected as subjects. Statistical methods such as t test, Mann-Whitney U test, Chi-square test and Kaplan-Meier were used for data analysis. Patients who achieved sustained renal response were included in the effective group (n=45) and those who had no response or relapse were included in the ineffective group (n=47) based on results of 3-year follow-up. The general condition and laboratory test results were compared between the two groups.

Results The 92 patients with refractory LN were followed up for 3 years, and 45 patients achieved sustained renal response. The overall response rate (complete response rate and partial response rate) was 48.9% (45/92), with complete response rate of 6.5% (6/92) and partial response rate of 42.4% (39/92); thirty-seven patients had no remission and 10 relapsed after remission. Endpoint events occurred in 17 patients (4 died and 13 remained dialysis), and the incidence of endpoint events was 18.5% (17/92); a total of 4 patients died, and theoverall survival rate was 95.7% (88/92). There were significant differences in baseline serum creatinine (SCr), glomerular filtration rate (eGFR) and kidney score in Lupus Assessment UK group (BILAG) between effective and ineffective groups. COX multivariate regression analysis showed that baseline eGFR level was a prognostic factor (P < 0.05).

Conclusions UC-MSC in treatment of refractory LN has good efficacy and long-term prognosis, and low baseline eGFR level is a risk factor affecting the efficacy.