Timely referral to kidney transplant may improve survival for patients with lupus nephritis

Patients with lupus nephritis and end stage renal disease may benefit from timely kidney transplant, as transplantation was associated with a significant increase in survival in a nationwide cohort study. The main reason for the overall survival benefit was fewer deaths due to cardiovascular disease and infections. The findings are published in Annals of Internal Medicine.

The risk for kidney failure from lupus nephritis is high and has not changed in the past 20 years, despite advances in diagnosis and treatment options. While renal transplantation has been associated with improved survival in the all-cause end stage renal disease population, clinicians proceed with caution for patients with lupus nephritis over fears of infection and other post-transplant complications.

Researchers from Massachusetts General Hospital studied a national database comprised of almost all patients with end stage renal disease to assess outcomes of patients with lupus nephritis who initiated dialysis and were placed on the waitlist for a kidney transplant. They found that transplant was associated with a 70 percent reduction in overall risk for death. The survival benefit persisted in key subgroups, including African Americans, Hispanics, and Asians, as well as in both sexes, in all age groups, and throughout the study period.

According to the authors of an accompanying editorial from Tufts Medical Center, these findings are strong and have implications for clinical practice. They say that kidney transplant should be part of the treatment plan for patients with lupus nephritis and should be emphasized before the onset of kidney failure. In addition, they suggest considering wider use of preemptive transplant in this population.