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Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System
  1. Zachary S Wallace1,2,3,4,
  2. Rachel Wallwork3,
  3. Yuqing Zhang1,2,3,
  4. Na Lu1,2,3,
  5. Frank Cortazar3,4,5,
  6. John L Niles3,4,5,
  7. Eliot Heher3,6,
  8. John H Stone1,2,3,4,
  9. Hyon K Choi1,2,3
  1. 1 Rheumatology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Renal Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  6. 6 Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Zachary S Wallace, Rheumatology Unit, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; zswallace{at}mgh.harvard.edu

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.

  • granulomatosis with polyangiitis
  • epidemiology
  • outcomes research

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Footnotes

  • Handling editor Josef S Smolen

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • 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.

  • Patient consent Not required.

  • Ethics approval The IRB has determined that this activity does not meet the definition of human subjects research. The investigators conducting this research will not obtain data through an intervention or interaction with individual subjects or identifiable private information about living individuals. This study was exempted from the Partner’s HealthCare Institutional Review Board because it only used deidentified data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data collected by the United States Renal Data System (USRDS) are extensive and maintained by the National Institutes of Health. Details regarding the data collected can be reviewed at this website: https://www.usrds.org/

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