In patients with end-stage renal disease (ESRD) attributed to granulomatosis with polyangiitis (GPA), renal transplantation is associated with a significant survival benefit, largely because of the sharp reduction in the risk for death from cardiovascular disease (CVD), according to the results of an analysis of patients from the US Renal Data System (USRDS) published in the Annals of the Rheumatic Diseases.
Renal transplantation is known to be the optimal treatment for select patients with ESRD. The investigators sought to examine the survival benefit of renal transplantation among patients with ESRD that is attributed to GPA (ESRD-GPA). Patients from the USRDS with ESRD-GPA were identified between 1995 and 2014. The analysis was restricted to those on the transplant wait list to evaluate the effect of transplantation on mortality.
All patients were followed until death or the end of follow-up. The relative risk for all-cause and cause-specific mortality was compared among patients who received a transplant vs patients who did not receive a transplant.
Over the study period, a total of 1525 patients were put on the wait list and 946 received a renal transplant. Renal transplant was associated with a 70% reduction in the risk for all-cause mortality according to multivariable-adjusted analyses (relative risk [RR], 0.30; 95% CI, 0.25-0.37), which was mainly attributable to a 90% decrease in mortality risk from CVD (RR, 0.10; 95% CI, 0.06-0.16).
The investigators concluded that based on the results of this study, prompt referral for transplantation is crucial to optimize outcomes in patients with ESRD-GPA. They cautioned that the study has limitations, including that the USRDS enrolls patients when ESRD occurs, but it does not include any details with respect to history of GPA. They recommend that routine management of patients with GPA who have advanced chronic kidney disease should include an assessment for renal transplant eligibility.
Wallace ZS, Wallwork R, Zhang Y, et al. Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System [published May 14, 2018]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2018-213452