Impact of pre-transplant time on dialysis on survival in patients with lupus nephritis

Ntatsaki, Eleana; Velo-García, Alba; Vassiliou, Vassilios; Salama, Alan D.; Isenberg, David

doi:10.1007/s10067-018-4115-1

Cited by 8 publications

(8 citation statements)

References 22 publications

(25 reference statements)

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“…With an increasing number of pre-emptive transplantation 6,13 it is possible that non-adherence could also increase, and therefore the clinicians and other health care professionals should be aware and ever vigilant in recognizing this. We have recently shown that increasing time on dialysis prior to rTp adversely affects prognosis specifically in lupus patients, 14 supporting previous literature in patients with renal disease of mixed aetiology receiving rTp, 15 and therefore minimizing the time on dialysis should remain the aim. However, particular attention should be paid to the patients who spent little or no time on dialysis to ensure that non-adherence does not compromise the beneficial effects of early transplantation.…”

Section: Discussionsupporting

confidence: 84%

Renal transplantation for lupus nephritis: non-adherence and graft survival

Ntatsaki

Vassiliou

Velo-García

et al. 2019

Lupus

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Poor adherence to immunosuppressive treatment is common in patients with systemic lupus erythematosus and may identify those with lupus nephritis (LN) who have a poorer prognosis. Non-adherence has also been reported to be a potential adverse outcome predictor in renal transplantation (rTp). We investigated whether non-adherence is associated with increased rTp graft rejection and/or failure in patients with LN. Methods Patients with LN undergoing rTp in two major London hospitals were retrospectively included. Medical and electronic records were reviewed for documented concerns of nonadherence as well as laboratory biochemical drug levels. The role of non-adherence and other potential predictors of graft rejection/ failure including demographics, comorbidities, age at SLE and LN diagnosis, type of LN, time on dialysis prior to rTp and medication use were investigated using logistic regression. Results Out of 361 patients with LN, 40 had renal transplantation. During a median follow up of 8.7 years, 17/40 (42.5%) of these patients had evidence of non-adherence. A total of 12 (30.0%) patients experienced graft rejection or failure or both. In the adherent group 2/23 (8.7%) had graft rejection, whilst in the non-adherent this rose to 5/17 (29.4%, p=0.11). Graft failure was seen in 5/23 (21.7%) patients from the adherent group and 4/17 (23.5%) in the non-adherent group (p=0.89). Non-adherent patients had a trend towards increased graft rejection, hazard ratio 4.38, 95% CI=0.73-26.12, p=0.11. Patients who spent more time on dialysis prior to rTp were more likely to be adherent to medication, p=0.01. Conclusion Poor adherence to immunosuppressive therapy is common and has been shown to associate with a trend towards increased graft failure in patients with LN requiring renal transplantation. This is the first paper to report that shorter periods on dialysis prior to transplantation might lead to increased non-adherence in lupus patients.

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Section: Discussionsupporting

confidence: 84%

Renal transplantation for lupus nephritis: non-adherence and graft survival

Ntatsaki

Vassiliou

Velo-García

et al. 2019

Lupus

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“…Tsai [19] opposed by Krane [20], reported more SLE disease activity in hemodialysis patients than in peritoneal dialysis, Chang [21] opposed by Kang [13], reported higher risk of infections in hemodialysis than peritoneal dialysis patients, Tsai [19] opposed by Weng [22], reported a higher risk of allcause cardiovascular events in hemodialysis than peritoneal dialysis and Wu [23] opposed by Contreras [24], reported a higher risk of mortality in hemodialysis than in peritoneal group. Ntatsaki et al [16] in a large study reported similar risks of mortality between the groups.…”

Section: Introductionmentioning

confidence: 73%

“…From 16 ultimately eligible studies, 15,636 patients were diagnosed to have LN-ESRD prior to renal transplantation. Of 15,636 patients, 4616 were on hemodialysis and 2089 were on peritoneal dialysis, 280 directly underwent kidney transplantation, 8319 were eliminated in 1 study [24] after matching participants utilizing propensity scores by the primary author and for 332 participants details were not reported [16]. All 16 studies reported 1 or more outcomes of interest.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Systematic review and meta-analysis of clinical outcomes comparison between different initial dialysis modalities in end-stage renal disease patients due to lupus nephritis prior to renal transplantation

et al. 2020

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Background: Regarding lupus disease activity, morbidity and survival, limited literature concluded conflicting results when comparing hemodialysis versus peritoneal dialysis as initial renal replacement therapies (RRT) prior to transplantation, in lupus nephritis end-stage renal disease (LN-ESRD) patients. This study was aimed to compare the risks of lupus flares, all-cause infections, all-cause cardiovascular events, and mortality, between hemodialysis versus peritoneal dialysis as initial RRT-modality before renal-transplant in LN-ESRD patients, by systematic review and meta-analysis. Methods: PubMed, EMBASE, and SCOPUS were searched for observational-studies comparing LN-ESRD-patients undergoing hemodialysis (Group1) versus peritoneal-dialysis (Group 2) prior to renal-transplantation, by their risks of lupus flare, all-cause infections, all-cause cardiovascular events, and mortality as outcome measures. Relative-Risks of outcomes between the groups measured overall effects at a 95% significance level. RevMan 5.3 computer software was used for analysis. Results: From search, 16 eligible studies reported 15,636 LN-ESRD-patients prior to renal transplantation with 4616 patients on hemodialysis, 2089 on peritoneal dialysis, 280 directly underwent kidney transplantation, 8319 were eliminated with reasons and 332 participants' details were not reported. Hemodialysis group had higher risk of allcause cardiovascular events, Relative-Risk = 1.44 (Confidence Interval:1.02, 2.04), p-Value< 0.05. With regards to risks for mortality, flare and all-cause infections, there were trends that were not statistically significant (p-Value> 0.05). Conclusion: Except for all-cause cardiovascular events in which peritoneal dialysis is superior to hemodialysis offering better outcomes, both treatment modalities offer more or less similar clinical outcomes as effective initial choices of RRT in LN-ESRD patients prior to renal transplant.

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“…6 Furthermore, patient and graft survival rates among SLE patients are similar to those of transplant recipients with other causes of ESKD. 4,5,[7][8][9][10][11][12][13][14][15][16][17][18][19] The recurrence of LN (RLN) in the kidney graft remains a major concern, as it increases the risk of graft loss. [20][21][22] The reported rate of RLN in the graft ranges from 0 to 54%.…”

Section: Introductionmentioning

confidence: 99%

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America

Rodelo

González

Ustáriz

et al. 2021

Lupus

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Objective We assessed patient and graft outcomes and prognostic factors in kidney transplantation in patients with end-stage kidney disease (ESKD) secondary to lupus nephritis (LN) undergoing kidney transplantation from August 1977 to December 2014 in a Latin American single center. Methods The primary endpoint was patient survival, and the secondary endpoints were death-censored graft survival for the first renal transplant and the rate of recurrent LN (RLN). Kaplan–Meier method was used for survival analysis. Factors predicting patient and death-censored graft survivals were examined by Cox proportional-hazards regression analyses. Results 185 patients were retrospectively evaluated. Patient survival rates were 88% at one year, 82% at three years, 78% at five years, and 67% at ten years. Death-censored graft survival for the first renal transplant was 93% at one year, 89% at three years, 87% at five years, and 80% at ten years. RLN was diagnosed in 2 patients (1.08%), but no graft was lost because of RLN. Thirty-nine (21.1%) patients died, and 65 (35.1%) patients experienced graft loss during the follow-up. By multivariable analyses, older recipient age and 1-month posttransplantation eGFR <45 ml/min/1.73m2 were associated with lower patient survival and an increased risk of graft loss, while induction immunosuppressive therapy exerted a protective effect on patients’ survival. In the subgroup of patients in whom disease activity was measured at the time of transplantation, a higher SLEDAI score was also associated with lower patient survival and an increased risk of graft loss. Conclusion In a mostly Mestizo population, kidney transplantation is an excellent therapeutic alternative in LN patients with ESKD. Older recipient age, an eGFR <45 ml/min/1.73m2 at one month posttransplantation, and disease activity at the time of transplantation are predictive of a lower patient and death-censored graft survival, while induction immunosuppressive therapy has a protective effect on patient survival. RLN is rare and does not influence the risk of graft loss.

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Impact of pre-transplant time on dialysis on survival in patients with lupus nephritis

Cited by 8 publications

References 22 publications

Renal transplantation for lupus nephritis: non-adherence and graft survival

Renal transplantation for lupus nephritis: non-adherence and graft survival

Systematic review and meta-analysis of clinical outcomes comparison between different initial dialysis modalities in end-stage renal disease patients due to lupus nephritis prior to renal transplantation

Kidney transplantation outcomes in lupus nephritis: A 37-year single-center experience from Latin America

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