SLE impacts survival after kidney transplant
medwireNews: A retrospective cohort study shows that patients with systemic lupus erythematosus (SLE) have similar kidney failure outcomes to non-SLE patients, but a higher risk for death after transplantation.
As reported in the American Journal of Kidney Diseases, the researchers analyzed data from 280,892 individuals in the European Renal Association Registry who received kidney replacement therapy (KRT) for kidney failure between 1992 and 2016.
Of these individuals, 1826 (0.65%) had SLE (median age at disease onset 42.9 years, 79% women), giving an incidence for KRT among these patients of 0.80 per million population per year. The annual percent change over the 25 years was 0.1%, indicating a “stable” incidence over this time, the investigators report.
Ten-year overall survival (OS) studied in patients initiating KRT between 1992 and 2006 was similar between 1056 SLE patients and 5280 patients matched for age and sex who were receiving KRT for kidney disease unrelated to SLE, with a nonsignificant hazard ratio of 1.11 after adjusting for factors including dialysis vintage, country, and time period.
Despite there being no significant difference in OS between the two groups, a significantly higher proportion of deaths in the SLE group were attributed to infection (24.8 vs 16.9%), but conversely, significantly fewer were attributed to malignancy (5.4 vs 8.7%).
More patients in the SLE versus non-SLE arm had a kidney transplant within 10 years of initiating KRT, with corresponding rates of 46.9% versus 51.9%.
Among the matched 999 SLE patients and 4995 non-SLE patients who received a transplant, the risk for death was a significant 25% higher in the SLE patients. There was, however, no difference in graft survival between the two treatment groups.
Anneke Kramer (University of Amsterdam, the Netherlands) and colleagues say the “unfavorable effect on overall patient survival after kidney transplantation” associated with SLE “may be caused by disease-specific complications but may also in part be due to complications arising from long-term immunosuppressive burden.”
They conclude: “Therapeutic advances resulting from better understanding of these complications have the potential to improve survival after kidney transplantation in patients with SLE.”
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