Kidney transplantation improves cardiovascular outcomes in patients with lupus nephritis (LN), but many patients fail to receive it, a new study finds.

Of 5963 waitlisted patients with LN and end-stage kidney disease (LN-ESKD) in the US Renal Data System (USRDS) from 2000 to 2016, only 3209 (54%) received a kidney transplant during the study period. Kidney transplantation was associated with a significant 69% lower risk of nonfatal and fatal cardiovascular events compared with no transplantation, April Jorge, MD, of Harvard Medical School and Massachusetts General Hospital in Boston, and colleagues reported in Arthritis Care & Research. Specifically, it was associated with significant 87% and 70% lower risks of myocardial infarction and cerebrovascular accidents (ischemic stroke and transient ischemic attack), respectively.

“The mechanisms of [cardiovascular] risk reduction with kidney transplantation among patients with LN-ESRD are likely similar as in patients with all-cause ESRD, primarily related to the prevention of accelerated progression of atherosclerosis which is known to occur with the alternative of remaining on dialysis,” the investigators explained.

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Recipients older and younger than 40 years had a significant 62% and 73% reduction in atherosclerotic event risk, respectively. Recipients of living and deceased donor kidneys had a significant 79% and 76% reduction in atherosclerotic event risk, respectively.

White recipients had a significant 88% reduction in atherosclerotic risk. For Black patients, the result did not reach significance. Black patients represented 48% of waitlisted and 43% of transplanted patients.

“Our findings highlight the importance of identifying barriers to transplantation in this [LN] population, as improved access could reduce [cardiovascular] morbidity,” Dr Jorge’s team stated.

The study authors noted that Black patients may have disparate access to early transplantation and a higher risk of graft failure. Further research is warranted to understand the complex interplay of race, lupus, kidney failure, and cardiovascular risks, they acknowledged.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Jorge A, Fu X, Cook C, et al. Kidney transplantation and cardiovascular events among patients with end-stage renal disease due to lupus nephritis: a nationwide cohort study. Arthritis Care Res. Published June 3, 2021. doi:10.1002/acr.24725