Renal Transplant in Lupus

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Renal transplant can substantially improve survival rates for patients with lupus nephritis, according to new research.

Results from a new study published in the Annals of Internal Medicine show lupus nephritis-end stage renal disease (LN-ESRD) patients have lower overall mortality rates and lower disease-specific mortality rates post-transplant. These findings contradict existing concerns that these patients might have higher infection risks due to the intensive immunosuppression therapies.

“Our findings suggest that timely referral for transplant in this population may alleviate both cardiovascular disease mortality and infection-related mortality,” investigators said.

To study transplant effects, investigators analyzed data on 9,659 waitlisted patients. Deceased-donor transplants occurred in 3,720 patients (65 percent), and 2,015 living-donor transplants (35 percent) were completed. During follow-up 973 patients who received a transplant and 1,697 who didn’t died, leading to a mortality rate of 22.5 per 1,000 person years.

Researchers evaluated all-cause mortality and primary cause of death, including cardiovascular disease (coronary heart disease and stroke), infection (pneumonia and sepsis), and cancer.

The average age at time of waitlist was 38, and the average age at transplant was 39. Of the patient population, 82 percent were women, 48 percent were African-American, and 21 percent were Hispanic. Hypertension was the most common co-morbidity, affecting 79 percent of individuals.

According to results, renal transplant demonstrated a 70-percent death risk reduction. This effect was similarly seen across African-American, Asian, Hispanic, and white patients, as well as age of ESRD onset, year of ESRD onset, and sex. Among specific causes of death, renal transplant provided a 74-percent lower cardiovascular disease death risk, specifically a 70-percent lower coronary heart disease death risk and a 61-percent lower stroke death risk.

Patients who received transplants also experienced a 59-percent reduced mortality risk from sepsis. Research results found no statistically-significant association between renal transplant and cancer death risk.

Ultimately, investigators said, these results, including data on waitlisted patients who died before transplant, support using renal transplant with lupus nephritis patients.

“Timely consideration of renal transplant should be a part of routine care for patients with LN-ESRD,” they said, “and improved access to renal transplantation for this population may considerably improve outcomes.”

REFERENCE
Jorge A, Wallace Z, Lu N, Zhang Y, Choi H, Renal Transplantation and Survival Among Patients With Lupus Nephritis. Annals of Internal Medicine (2019), doi:10/7326/M18-1570