Lupus Nephritis Patients with End-stage Renal Disease Benefit from Transplant

A recent cohort study found that lupus nephritis patients with end-stage renal disease (LN-ESRD) may significantly decrease their mortality risk by undergoing a renal transplant.

The study consisted of data from the United States Renal Data System on LN-ESRD patients who were put on a waitlist for a renal transplant. Primary outcomes were all-cause and cause-specific mortality. Researchers calculated hazard ratios (HRs) using time-dependent Cox regression analysis.

A total of 9,659 LN-ESRD patients were put on a renal transplant waitlist during the study period; 59% (n = 5,738) had a transplant. Waitlisted patients who underwent transplant had a lower all-cause morality risk (adjusted HR, 0.30 [95% CI, 0.27 to 0.33]). Cause-specific mortality adjusted HRs were as follows: cardiovascular disease, 0.26 (CI, 0.23 to 0.30); coronary heart disease, 0.30 (CI, 0.19 to 0.48); infection, 0.41 (CI, 0.32 to 0.52); and sepsis, 0.41 (CI, 0.31 to 0.53).

One of the study’s limitations is that other factors not measured by the researchers could be impacting the results; still, they wrote, “the E-value analysis suggested robustness of the results.”

A previous study also found good outcomes for LN-ESRD patients, specifically in a Latin American cohort. Researchers evaluated data from 65 kidney transplants in LN-ESRD patients; survival at one, 10, and 15 years was 98% (P = 0.99). Graft survival rates were 92% at one year, 83% at five years, and 71% at 15 years. Two (3.1%) patients experienced recurrent disease, and one patient diagnosed with recurrent LN died from an infection. When controlling for age and sex, survival rates were still 98% after 15 years; when controlling for donor, five-year survival was 100% and 15-year survival was 98%. Graft survival rates in age- and sex- controlled analysis were 90% at one year, 84% at five years, and 64% at 15 years, and in donor-controlled analysis for the same time period were 89%, 86%, and 79%, respectively (P = 0.7718).

Researchers for the present study wrote of their findings, “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.”

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Source: Annals of Internal Medicine