Rates of premature death are high among patients with end-stage renal disease (ESRD) due to lupus nephritis (ESRD-LN). April Jorge, MD, and colleagues conducted a nationwide cohort study designed to examine the potential effect on survival of renal transplant among patients with ESRD-LN in the United States.
The study utilized data from the United States Renal Data System to identify patient with incident ESRD-LN who were waitlisted for a renal transplant. First renal transplant was analyzed as a time-varying exposure.
The primary outcomes of interest were all-cause and cause-specific mortality. In the primary analysis, hazard ratios (HRs) for the outcomes were estimated using time-dependent Cox regression analysis. In a secondary analysis limited to patients with Medicare, sequential cohort matching was used to allow assessment of time-varying covariates.
There were 9659 patients with LN-ESRD waitlisted for a renal transplant during the study period; of those, 59% (n=5738) received a transplant. Most (82%) of the eligible patients were female and 60% were nonwhite.
Among the waitlisted patients, there was an association between transplantation and reduced all-cause mortality (adjusted HR, 0.30; 95% confidence interval [CI], 0.27-0.33). Adjusted HRs for cause-specific mortality were 0.26 (95% CI, 0.23-0.30) for cardiovascular disease; 0.30 (95% CI, 0.19-0.48) for coronary heart disease; 0.41 (95% CI, 0.32-0.52) for infection; and 0.41 (95% CI, 0.31-0.53) for sepsis.
“Renal transplant was associated with a survival benefit, primarily due to reduced deaths from cardiovascular disease and infection. The findings highlight the benefit of timely referral for transplant to improve outcomes in this population,” the researchers said.