Elsevier

Transplantation Proceedings

Volume 43, Issue 10, December 2011, Pages 3713-3714
Transplantation Proceedings

Kidney transplantation
Outcome
Preemptive Kidney Transplantation in Systemic Lupus Erythematosus

https://doi.org/10.1016/j.transproceed.2011.08.092Get rights and content

Abstract

Preemptive kidney transplantation is associated with superior outcomes. Patients who have kidney failure due to systemic lupus erythematosus (SLE) may not receive a preemptive kidney transplant because of the concern for risk of disease recurrence with shortened graft and patient survival. We identified 8001 patients in the United Network for Organ Sharing dataset who underwent kidney transplantation between October 1987 and February 2009 with kidney failure due to SLE. Seven hundred thirty patients received a preemptive kidney transplant with 7271 patients who were on dialysis before transplantation; their mean ages were 40.0 ± 11.6 years and 36.9 ± 11.7 years, respectively, (P < .01). Women constituted 82.5% of preemptive and 81.4% of non-preemptive groups (P = .47). Preemptive transplant recipients were more likely to receive a living donor kidney transplant (odds ratio [OR] = 3.6; 95% confidence interval [CI] = 3.3–4.5; P < .01). In unadjusted analyses, preemptive transplantation was associated with lower risk of recipient death (hazard ratio [HR] = 0.52; 95% CI = 0.38–0.70; P < .01). The difference remained significant after adjustment fr covariates (HR = 0.55; 95% CI = 0.36–0.84; P < .01). Graft survival was also superior among preemptive kidney transplant recipients in both unadjusted (HR = 0.56; 95% CI = 0.49–0.68; P < .01), and adjustment analyses (HR = 0.69; 95% CI = 0.55–0.86; P < .01). We concluded that preemptive kidney transplantation among patients with SLE was associated with superior patient and graft outcomes and should be considered when feasible.

Section snippets

Methods

All patients in the United Network for Organ Sharing dataset who underwent a kidney transplant with kidney failure due to SLE were analyzed. Graft and patient survival for the preemptive and non-preemptive groups, defined by a lack of or prior exposure to dialysis, was determined by using the Kaplan-Meier and Proportional Hazards techniques, with adjustment for confounders known to impact outcomes.

Results

We identified 8001 patients who underwent a kidney transplant between October 1987 and February 2009 with kidney failure due to SLE. Seven hundred thirty patients received a preemptive transplant with 7271 patients who were on dialysis before transplantation, with a mean age of 40.0 ± 11.6 years and 36.9 ± 11.7 years (P < .01), respectively. Women constituted 82.5% of preemptive and 81.4% of the non-preemptive groups (P = .47). Preemptive transplant recipients were more likely to receive a

Discussion

Preemptive kidney transplantation has been associated with superior graft and patient outcomes.1, 2, 3 The primary objective of this study was to compare posttransplant outcomes among patients with kidney failure due to SLE because it has been proposed that pretransplant dialysis in patients with lupus nephritis may permit the disease to become quiescent, hence reducing the risk of disease recurrence in the transplant kidney and improve graft survival.4, 5 However, the current study alleviates

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