Renal transplant improves survival among lupus nephritis patients with ESRD
Renal transplantation confers survival benefits to patients with end-stage renal disease (ESRD) due to lupus nephritis (LN), driven primarily by reduced deaths from cardiovascular disease and infection, a study has shown.
“The findings highlight the benefit of timely referral for transplant to improve outcomes in this population,” the investigators said.
Of the 9,659 patients with LN-ESRD who were waitlisted for a renal transplant during the study period, 5,738 (59 percent) had a transplant. Most patients were female (82 percent) and nonwhite (60 percent).
Among waitlisted patients, an association was found between transplant and reduced all-cause mortality (adjusted hazard ratio [HR], 0.30; 95 percent CI, 0.27‒0.33). Adjusted HRs for cause-specific mortality were as follows: 0.26 (0.23‒0.30) for cardiovascular disease, 0.30 (0.19‒0.48) for coronary heart disease, 0.41 (0.32‒0.52) for infection and 0.41 (0.31‒0.53) for sepsis.
To examine the potential effect of renal transplant on survival, this nationwide cohort study enrolled patients with incident LN-ESRD who were waitlisted for a renal transplant. Analysis was conducted on first renal transplant as a time-varying exposure.
All-cause and cause-specific mortality were the primary outcomes. The investigators used time-dependent Cox regression analysis to estimate the HR of these outcomes associated with renal transplant in the primary analysis. Sequential cohort matching was used in a secondary analysis limited to patients with Medicare, which allowed assessment of time-varying covariates.
The study was limited by unmeasured factors that could have contributed to the observed associations. However, the E-value analysis suggested robustness of the findings, according to the investigators.