Patients with end-stage renal disease due to granulomatosis with polyangiitis — a type of ANCA-associated vasculitis — live significantly longer after receiving a kidney transplant, a nationwide review study shows.
This was mainly due to a 90% reduction in the risk for cardiovascular death, researchers found.
The findings suggest that promptly referring these patients for kidney transplant is key to their survival.
The study, “Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System,” was published in the Annals of the Rheumatic Diseases.
Granulomatosis with polyangiitis (GPA), a condition characterized by inflammation of small blood vessels, may lead to kidney disease in 70% of patients.
Among them, nearly one in four ends up developing end-stage renal disease (ESRD) — when the kidneys no longer work as they should — a condition which can only be treated with a kidney transplant.
GPA with ESRD is associated with a high risk of death, usually due to serious cardiovascular events. But whether kidney transplants could reduce that risk had been uncertain.
To evaluate the survival benefit of kidney transplant in GPA patients, researchers at Massachusetts General Hospital and Harvard Medical School reviewed data from the United States Renal Data System (USRDS), a national collection of information about nearly 94% of patients who receive dialysis or kidney transplants in the U.S.
Investigators examined data from 5,929 patients diagnosed with end-stage renal disease due to GPA between 1995 and 2014. During this time, 1,525 patients were placed on a wait list for a transplant, but only 946 received one.
During follow-up, 438 patients died. These included 199 patients who received a transplant (21%) and 239 patients of the 579 who did not receive a new kidney (41%). This represented a 70% reduction in the risk of death, the team found.
Age at ESRD onset and sex did not impact this survival benefit. However, patients younger than 40 benefited the most from kidney transplant — there was an 81% reduction in their risk of death. Patients older than 60 saw a 62% mortality risk reduction.
Interestingly, the team found that the reduced risk of mortality was primarily due to a significant reduction in cardiovascular events. Patients who received transplants had a 90% lower risk of death due to cardiovascular disease than non-transplant patients.
The findings have “important implications for the management of [ANCA]-associated vasculitis patients with advanced renal involvement,” researchers wrote.
“Prompt referral for transplantation is critical to optimize outcomes for this patient population,” they said.