Kidney Transplantation Ups Survival in Lupus Nephritis Cases

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In a nationwide study, renal transplant recipients with lupus nephritis had a 70% lower risk for all-cause mortality than nonrecipients.
In a nationwide study, renal transplant recipients with lupus nephritis had a 70% lower risk for all-cause mortality than nonrecipients.

Kidney transplantation improves survival for patients with end-stage renal disease due to lupus nephritis (LN-ESRD), new study findings confirm.

Of 9659 patients with new-onset LN-ESRD enrolled in the United States Renal Data System from January 1, 1995 to December 31, 2014 and who were on the kidney transplant waiting list, 5783 (59%) eventually received a kidney transplant from a living (35%) or deceased (65%) donor. During follow-up, 973 transplant recipients and 1697 nonrecipients died.

Kidney transplant recipients, who had a mean age 39 years, had a significant 70% lower risk of dying from any cause compared with nonrecipients, April Jorge, MD, of Massachusetts General Hospital in Boston, and colleagues reported in the Annals of Internal Medicine. Recipients had a significant 74%, 70%, and 61% lower risk of dying from cardiovascular disease, coronary heart disease, and stroke, respectively. In addition, they had a significant 59% lower risk of dying from either infection or from sepsis.

Most LN-ESRD patients were female and nonwhite. Investigators found that the survival benefit extended to African Americans, Hispanics, and Asians, male as well as female patients, and patients of all ages.

The medical community has been concerned that LN-ESRD patients have increased risks for post-transplant complications due to immunologic activity, including thrombotic events, or immunosuppressive therapy. Researchers involved with the current study could not determine whether lupus-related disease activity influenced nonreceipt of kidney transplant, which limits data interpretation.

“These unique concerns have limited the extrapolation of renal transplant outcomes from other groups of patients with ESRD to those with LN-ESRD,” Dr Jorge and his collaborators stated. “To that end, our study provides evidence for a substantial survival benefit of renal transplant among patients with LN-ESRD.”

They concluded that “timely consideration of renal transplant” and improved access should be routine care for LN-ESRD patients.

In an accompanying editorial, Nitender Goyal, MD, and colleagues from Tufts Medical Center in Boston concurred. “Because data from other studies have suggested higher patient and allograft survival with both preemptive and early kidney transplant, it is essential that transplant be considered as promptly as possible for patients with LN and that barriers to early transplant be surmounted.”

References

Jorge A, Wallace ZS, Lu N, et al. Renal transplantation and survival among patients with lupus nephritis. A cohort study. Ann Intern Med. 2019. [Published online January 22, 2019]. DOI:10.7326/M18-1570

Goyal N, Weiner DE, Levey AS. Kidney transplantation in lupus nephritis: Can we do even better? Ann Intern Med. 2019. [Published online January 22, 2019].

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