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. 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.

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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

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