Association of Time to Kidney Transplantation with Graft Failure among U.S. Patients with End-Stage Renal Disease Due to Lupus Nephritis

Details

• Alternative Title:
  Arthritis Care Res (Hoboken)
• Personal Author:
  Plantinga, Laura C. ; Patzer, Rachel E. ; Drenkard, Cristina ; Kramer, Michael R. ; Klein, Mitchel ; Lim, S. Sam ; McClellan, William M. ; Pastan, Stephen O.
• Description:
  Objective
  
  Providers recommend waiting to transplant patients with end-stage renal disease (ESRD) secondary to lupus nephritis (LN), to allow for quiescence of systemic lupus erythematosus (SLE)-related immune activity. However, these recommendations are not standardized, and we sought to examine whether duration of time to transplant was associated with risk of graft failure in U.S. LN-ESRD patients.
  
  Methods
  
  Using national ESRD surveillance data (United States Renal Data System), we identified 4743 U.S. patients with LN-ESRD who received a first transplant on or after 1/1/00 (follow-up through 9/30/11). The association of wait time (time from ESRD start to transplant) with graft failure was assessed with Cox proportional hazards models, with splines of the exposure to allow for non-linearity of the association and with adjustment for potential confounding demographic, clinical, and transplant factors.
  
  Results
  
  White LN-ESRD patients who were transplanted later (vs. <3 months on dialysis) were at increased risk of graft failure [adjusted HR (95% confidence interval): 3–12 months, 1.23 (0.93–1.63); 12–24 months, 1.37 (0.92–2.06); 24–36 months, 1.34 (0.92–1.97); and >36 months, 1.98 (1.31–2.99)]. However, no such association was seen among black recipients [3–12 months, 1.07 (0.79–1.45); 12–24 months, 1.01 (0.64–1.60); 24–36 months, 0.78 (0.51–1.18); and >36 months, 0.74 (0.48–1.13)].
  
  Conclusion
  
  While future studies are needed to examine the potential confounding effect of clinically recognized SLE activity on the observed associations, these results suggest that longer wait times to transplant may be associated with equivalent or worse, not better, graft outcomes among LN-ESRD patients.
  
  
• Subjects:
  Adult Female Follow-Up Studies Graft Rejection Humans Kidney Failure, Chronic Kidney Transplantation Lupus Nephritis Male Middle Aged Time-to-Treatment Time Factors Treatment Failure Waiting Lists Young Adult

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• Source:
  Arthritis Care Res (Hoboken). 67(4):571-581
• Pubmed ID:
  25251922
• Pubmed Central ID:
  PMC4370810
• Document Type:
  Journal Article
• Funding:
  KL2-TR-000455/TR/NCATS NIH HHS/United States ; R01 AR065493/AR/NIAMS NIH HHS/United States ; KL2 TR000455/TR/NCATS NIH HHS/United States ; K01 HD074726/HD/NICHD NIH HHS/United States ; R01-AR-065493/AR/NIAMS NIH HHS/United States ; R24 MD008077/MD/NIMHD NIH HHS/United States ; K01-HD-074726/HD/NICHD NIH HHS/United States ; UL1-TR-000454/TR/NCATS NIH HHS/United States ; UL1 TR000454/TR/NCATS NIH HHS/United States ; 1R24-MD-008077-01/MD/NIMHD NIH HHS/United States ; U01 DP005119/DP/NCCDPHP CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  67
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:4a08018a7c7e3c42eb5d0871e08c77bdf888d9d8e8450e32b0747aa10c40e8ba
• Download URL:
  https://stacks.cdc.gov/view/cdc/82841/cdc_82841_DS1.pdf
• File Type:
  [PDF - 997.43 KB ]