Renal transplant ups survival in lupus-related ESRD

  • Jorge A & al.
  • Ann Intern Med
  • 22 Jan 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Renal transplant reduces mortality risk by 70% in patients with lupus nephritis (LN) and end-stage renal disease (ESRD).
  • Risk reduction was driven primarily by decreased death from cardiovascular disease (CVD) and infection.

Why this matters

  • Despite demonstrated survival benefit in ESRD, clinicians often hesitate to recommend transplant in LN-ESRD due to concerns over infection and other complications.
  • Findings suggest that renal transplant should be routinely considered for LN and emphasized before ESRD onset, the authors of an accompanying editorial suggest.

Study design

  • Study of 9659 patients with LN-ESRD in the U.S. Renal Data System waitlisted for a renal transplant.
  • 5738 (59%) underwent transplant (82% female, 48% African American, 21% Hispanic).
  • Funding: NIH.

Key results

  • Mortality rate was lower with transplant vs without (22.5 vs 56.3 per 1000 person-years).
  • In multivariate analysis, transplant was tied to reduced all-cause mortality (aHR=0.30; 95% CI, 0.27-0.33).
  • The effect was consistent across racial groups and in subgroup analysis stratified by sex, age at ESRD onset, and Medicare status.
  • Reduced overall mortality was driven by:
    • 74% lower risk for CVD (aHR=0.26; 95% CI, 0.23-0.30).
    • 70% lower risk for coronary heart disease (aHR=0.30; 95% CI, 0.19-0.48).
    • 59% lower risk for infection (aHR=0.41; 95% CI, 0.32-0.52).
    • 59% lower risk for sepsis (aHR=0.41; 95% CI, 0.31-0.53).

Limitations

  • Pretransplant disease activity not captured.