Survival Benefit of Kidney Transplant in Lupus Nephritis

Full access

Kidney transplantation reduces mortality, mainly due to cardiovascular disease and infection, in patients with lupus nephritis, reports a study in Annals of Internal Medicine.

Through the United States Renal Data System, the researchers identified 20,974 individuals with kidney failure due to lupus nephritis (ESRD-LN) between 1995 and 2014. Of 9659 waitlisted patients, 5738 (59%) received a kidney transplant. Eighty-two percent of waitlisted patients were women and 60% were nonwhite.

Analyzed as a time-varying exposure, renal transplantation was associated with lower all-cause mortality among waitlisted patients: adjusted hazard ratio (HR) 0.30. There were also significant reductions in mortality due to cardiovascular disease, HR 0.26; coronary heart disease, HR 0.41; and infection or sepsis, HR 0.41 for each. The survival benefit remained significant for subgroups defined by race/ethnicity, sex, and age and throughout the study period.

Secondary analysis of a Medicare-enrolled subset included matched groups of 2963 patients with and without transplantation. Mortality rates were 21.1 and 77.1 per 1000 person-years, respectively. Adjusted HRs for death were 0.32 for deceased-donor and 0.24 for living-donor recipients.

Patients with ESRD-LN are at high risk of premature death, compared to systemic lupus erythematosus patients without kidney involvement. The survival benefit of renal transplantation in ESRD-LN patients remains unclear.

This study finds a “considerable survival benefit” of kidney transplantation in a nationwide cohort of patients with LN-ESRD. The reduction in mortality results largely from lower risks of deaths due to cardiovascular disease and infections, particularly sepsis. The researchers conclude: “Therefore, timely consideration of renal transplant should be a part of routine care for patients with LN-ESRD, and improved access to renal transplantation for this population may considerably improve outcomes” [Jorge A, et al. Renal transplantation and survival among patients with lupus nephritis: a cohort study. Ann Intern Med 2019; DOI: 10.7326/M18-1570].