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Renal transplantation improves survival in lupus nephritis

Patients with lupus nephritis-related end-stage renal disease who received a renal transplant demonstrated a significant reduction in overall mortality, according to findings published in Annals of Internal Medicine.

“Lupus nephritis affects 30% to 50% of all patients with systemic lupus erythematosus and leads to end-stage renal disease in up to 20% of affected patients,” April Jorge, MD, instructor in medicine at Massachusetts General Hospital, and colleagues wrote. “Those with end-stage renal disease due to lupus nephritis have a substantially higher risk for premature death than other patients with systemic lupus erythematosus.”

“The potential survival benefit associated with renal transplant remains unclear among patients with lupus nephritis end-stage renal disease,” they added.

Jorge and colleagues conducted a nationwide cohort study to investigate whether renal transplant improves the risk for all-cause and cause-specific mortality in patients with end-stage renal disease due to lupus nephritis. The researchers enrolled 9,659 patients from the United States Renal Data System. Participants had incident lupus nephritis with end-stage renal disease, initiated dialysis and were waitlisted for a renal transplant.

More than half (59%; n = 5,738) of participants — mainly women (82%) and nonwhites (60%) — received a renal transplant.

After adjusting for time-varying comorbid conditions, receiving a transplant was associated with a 70% lower risk of all-cause mortality (adjusted HR = 0.3; 95% CI, 0.27-0.33). Additionally, renal transplants were associated with reduced risks for CVD (aHR = 0.26; 95% CI, 0.23-0.3), coronary heart disease (aHR = 0.3; 95% CI, 0.19-0.48), infection (aHR = 0.41; 95% CI, 0.32-0.52) and sepsis (aHR = 0.41; 95% CI, 0.31-0.53).

The survival benefit was sustained throughout the study among blacks, Hispanics and Asians, both genders and all ages, according to the researchers.

“Timely consideration of renal transplant should be a part of routine care for patients with lupus nephritis end-stage renal disease, and improved access to renal transplantation for this population may considerably improve outcomes,” Jorge and colleagues concluded.

In an accompanying editorial, Nitender Goyal, MD, medical director of the Kidney Transplant Program at Tufts Medical Center, and colleagues wrote that the findings by Jorge and colleagues have important implications for clinical practice.

“Kidney transplant should be part of the treatment plan for patients with lupus nephritis and should be emphasized before the onset of kidney failure,” they wrote.

“It may be time to consider wider use of preemptive transplants in lupus nephritis,” they added. – by Alaina Tedesco

Disclosures: Goyal reports no relevant financial disclosures. Jorge reports receiving grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the NIH. Please see study and editorial for all other authors’ relevant financial disclosures.