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Association of Time to Kidney Transplantation with Graft Failure among U.S. Patients with End-Stage Renal Disease Due to Lupus Nephritis
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Apr 2015
Source: Arthritis Care Res (Hoboken). 67(4):571-581
Details:
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Alternative Title:Arthritis Care Res (Hoboken)
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Personal Author:
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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.
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Pubmed ID:25251922
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Pubmed Central ID:PMC4370810
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