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Association of Time to Kidney Transplantation With Graft Failure Among US Patients With End‐Stage Renal Disease Due to Lupus Nephritis
Author(s) -
Plantinga Laura C.,
Patzer Rachel E.,
Drenkard Cristina,
Kramer Michael R.,
Klein Mitchel,
Lim S. Sam,
McClellan William M.,
Pastan Stephen O.
Publication year - 2015
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22482
Subject(s) - medicine , hazard ratio , lupus nephritis , dialysis , end stage renal disease , proportional hazards model , confidence interval , transplantation , relative risk , confounding , kidney transplantation , hemodialysis , disease , surgery
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 US LN‐ESRD patients. Methods Using national ESRD surveillance data (United States Renal Data System), we identified 4,743 US patients with LN‐ESRD who received a first transplant on or after January 1, 2000 (followup through September 30, 2011). 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 nonlinearity of the association and with adjustment for potential confounding by demographic, clinical, and transplant factors. Results White LN‐ESRD patients who were transplanted later (versus at <3 months receiving dialysis) were at increased risk of graft failure (3–12 months: adjusted hazard ratio [HR] 1.23, 95% confidence interval [95% CI] 0.93–1.63; 12–24 months: adjusted HR 1.37, 95% CI 0.92–2.06; 24–36 months: adjusted HR 1.34, 95% CI 0.92–1.97; and >36 months: adjusted HR 1.98, 95% CI 1.31–2.99). However, no such association was seen among African American recipients (3–12 months: adjusted HR 1.07, 95% CI 0.79–1.45; 12–24 months: adjusted HR 1.01, 95% CI 0.64–1.60; 24–36 months: adjusted HR 0.78, 95% CI 0.51–1.18; and >36 months: adjusted HR 0.74, 95% CI 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.