Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep;77(9):1333-1338.
doi: 10.1136/annrheumdis-2018-213452. Epub 2018 May 14.

Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System

Zachary S Wallace  1   2   3   4 , Rachel Wallwork  3 , Yuqing Zhang  1   2   3 , Na Lu  1   2   3 , Frank Cortazar  3   4   5 , John L Niles  3   4   5 , Eliot Heher  3   6 , John H Stone  1   2   3   4 , Hyon K Choi  1   2   3
Affiliations

Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System

Zachary S Wallace et al. Ann Rheum Dis. 2018 Sep.

Abstract

Background: Renal transplantation is the optimal treatment for selected patients with end-stage renal disease (ESRD). However, the survival benefit of renal transplantation among patients with ESRD attributed to granulomatosis with polyangiitis (GPA) is unknown.

Methods: We identified patients from the United States Renal Data System with ESRD due to GPA (ESRD-GPA) between 1995 and 2014. We restricted our analysis to waitlisted subjects to evaluate the impact of transplantation on mortality. We followed patients until death or the end of follow-up. We compared the relative risk (RR) of all-cause and cause-specific mortality in patients who received a transplant versus non-transplanted patients using a pooled logistic regression model with transplantation as a time-varying exposure.

Results: During the study period, 1525 patients were waitlisted and 946 received a renal transplant. Receiving a renal transplant was associated with a 70% reduction in the risk of all-cause mortality in multivariable-adjusted analyses (RR=0.30, 95% CI 0.25 to 0.37), largely attributed to a 90% reduction in the risk of death due to cardiovascular disease (CVD) (RR=0.10, 95% 0.06-0.16).

Discussion: Renal transplantation is associated with a significant decrease in all-cause mortality among patients with ESRD attributed to GPA, largely due to a decrease in the risk of death to CVD. Prompt referral for transplantation is critical to optimise outcomes for this patient population.

Keywords: epidemiology; granulomatosis with polyangiitis; outcomes research.

PubMed Disclaimer

Conflict of interest statement

Competing interests: ZSW has received funding from a Scientist Development Award from the Rheumatology Research Foundation, a Fund for Medical Discovery Award from the Executive Committee on Research at Massachusetts General Hospital, and an NIH Loan Repayment Award.

Figures

Figure 1
Figure 1
Cumulative incidence of all-cause death according to transplant status among waitlisted patients with end-stage renal disease due to granulomatosis with polyangiitis.
Figure 2
Figure 2
Cumulative incidence of death due to cardiovascular disease according to transplant status among waitlisted patients with end-stage renal disease due to granulomatosis with polyangiitis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Moiseev S, Novikov P, Jayne D, et al. End-stage renal disease in ANCA-associated vasculitis. Nephrol Dial Transplant 2017;32:248–53. - PubMed
    1. Hruskova Z, Geetha D, Tesar V. Renal transplantation in anti-neutrophil cytoplasmic antibody-associated vasculitis. Nephrol Dial Transplant 2015;30(Suppl 1):i159–63. - PubMed
    1. Shen J, Gill J, Shangguan M, et al. Outcomes of renal transplantation in recipients with Wegener’s granulomatosis. Clin Transplant 2011;25:380–7. - PubMed
    1. Geetha D, Eirin A, True K, et al. Renal transplantation in antineutrophil cytoplasmic antibody-associated vasculitis: a multicenter experience. Transplantation 2011;91:1370–5. - PMC - PubMed
    1. Collins AJ, Foley RN, Herzog C, et al. Excerpts from the US renal data system 2009 annual data report. Am J Kidney Dis 2010;55(Suppl 1):A6–A7. - PMC - PubMed

MeSH terms