People with systemic lupus erythematosus (SLE) or granulomatosis with polyangiitis (GPA) who undergo kidney transplants have high survival rates over the long term without evidence of an increased risk of cancer, a study has found.
Titled “Long-Term Outcomes of Renal Transplant in Patients With End-Stage Renal Failure Due to Systemic Lupus Erythematosus and Granulomatosis With Polyangiitis,” the study was published in the journal Experimental and Clinical Transplantation.
Kidney disease is a common feature of autoimmune diseases such as SLE and GPA, which is a type of ANCA vasculitis. In cases of kidney failure, a transplant can be necessary. However, there are risks to transplants: for one, since these diseases are systemic (affecting the whole body), it is possible they can recur and affect the transplanted kidney(s) as well.
Additionally, the immune system is often suppressed with medicines, called immunosuppressants, following a transplant. This can lower the risk that the body will reject the transplanted organ, but it can also increase an individual’s risk of developing cancer.
Researchers conducted a review of people with SLE or GPA who were given kidney transplants at Beaumont Hospital in Dublin, Ireland, to investigate the long-term outcomes of patients with these conditions who undergo renal transplants.
They included data for a total of 98 transplants that were performed in 92 people (55 with SLE and 37 with GPA) between 1982 and 2017. Most (90) of the transplanted kidneys came from deceased donors; the rest were from relatives. The average follow-up time was 110.53 months (just over nine years).
Overall, the allograft survival rate — that is, the percentage of people in whom the transplanted kidneys continued to function properly — was 94.7% at one year, 85.4% at five years, and 75.4% at 10 years after the transplant. These rates were not significantly different between SLE (91.6% at one year, 84.3% at five years, and 74.4% at 10 years) and GPA (100% at one year, 92.4% at five years, and 92.4% at 10 years).
For comparison, the researchers calculated the overall allograft survival rate for kidney transplants done for reasons other than SLE or GPA in Ireland (where kidney transplant data is maintained in a national database). They determined the rates were 90.5% at one year, 76.7% at five years, and 58.5% at 10 years post-transplant.
These rates were not significantly different from those in people with GPA or SLE. A separate analysis in which patients who died were excluded — and so only non-fatal transplant failures were assessed — yielded similar rates, with again no significant differences among SLE, GPA, or other reasons for kidney transplant.
In total, there were 46 incidences of cancer diagnosed in 31 patients (18 with SLE and 13 with GPA), five of which were fatal. Most (32) of these were skin cancers. This rate of cancer was “similar to those shown in [kidney transplant] recipients without autoimmune diseases,” the researchers wrote.
The rates of cancer between people with GPA and SLE were comparable, though the researchers noted that cancer tended to occur sooner after transplant in people with GPA (average of 73.8 vs. 131.9 months post-transplant).
“We found that renal transplant is a feasible, safe, and effective treatment strategy for patients with [kidney failure] due to these systemic inflammatory conditions,” the researchers concluded. “We also noted excellent long-term renal allograft and overall patient survival rates that were either consistent with or exceeding rates shown in a national transplant recipient cohort.”
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