Transplant Outcomes Worse in Recipients With Lupus Nephritis – Renal and Urology News

Patients with lupus nephritis-related kidney failure are more likely to be evaluated for kidney transplantation, but their graft and patient survival appears worse compared with patients who have other causes of kidney failure, according to new research.

Among 192,318 patients with end-stage kidney disease (ESKD) from the eastern United States, 0.4% had lupus nephritis. The median time from ESKD diagnosis to transplant referral was similar between the lupus nephritis group and non- lupus nephritis groups:  median 2.9 vs 2.6 months. Approximately 58% of patients with lupus nephritis were referred, and two-thirds of these patients started transplant evaluation. In adjusted analyses, patients with lupus nephritis had a 13% higher likelihood of transplant evaluation, Laura McPherson, MPH, of Emory University in Atlanta, Georgia, and colleagues reported in Lupus.

“While providers may no longer be delaying the early steps in the kidney transplantation process among this patient population, there is still room for improvement in the rates of preemptive referral,” the investigators wrote.

Qichun Yin, MD, and colleagues from HuZhou University in Huzhou  City,  China, performed a separate systematic review and meta-analysis of 15 studies involving 6456 kidney transplant recipients with lupus nephritis and 168,529 patients without lupus nephritis as their cause of ESKD. The lupus nephritis group had a significant 6% greater risk of graft failure and a significant 15% greater risk of death, compared with patients with ESRD due to other causes, the investigators reported in Renal Failure. These findings were limited to recipients of deceased donor kidneys.

The systemic nature of lupus nephritis and comorbidity burden may make the lupus nephritis group more prone to transplant complications and earlier death, the investigators suggested. The “complex immune milieu” may lead to graft inflammation and dysfunction. “Living donor transplantation may offer a better outcome, and healthcare providers should consider this option when possible,” they wrote.

Lupus nephritis was strongly associated with lower graft and patient survival rates in included studies involving more than 200 patients. Case-control studies documented early mortality, whereas retrospective cohort studies documented an increased risk of poor graft survival with lupus nephritis.

The investigators urged multidisciplinary care of patients with lupus nephritis involving rheumatologists, nephrologists, and transplant specialists to address systemic autoimmune manifestations and transplant-related factors.

“Physicians and healthcare teams may need to intensify post-transplant care and surveillance for kidney transplant recipients with lupus nephritis, particularly those who received cadaveric donor kidneys, to detect and manage complications early.”