- 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 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.
- 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).
- Pretransplant disease activity not captured.