Kidney Week

Abstract: TH-PO757

Preemptive Kidney Transplantation Trends in Lupus

Session Information

• Transplantation: Clinical - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Contreras, Gabriel, University of Miami Miller School of Medicine, Miami, Florida, United States

Gabriel Contreras, MD, MPH

• Pagan, Javier, University of Miami Miller School of Medicine, Miami, Florida, United States

Javier Pagan, MD

• Elfassy, Tali, University of Miami Miller School of Medicine, Miami, Florida, United States

Tali Elfassy, MS, PhD

• Bandes, Miguel Antonio, University of Miami Miller School of Medicine, Miami, Florida, United States

Miguel Antonio Bandes, MD

• Bustamante, Nicolas, Universidad de Ciencias Medicas, San Jose, San José, Costa Rica

Nicolas Bustamante

• Goggins, Mariella Ortigosa, University of Miami Miller School of Medicine, Miami, Florida, United States

Mariella Ortigosa Goggins, MD

• Aponte Becerra, Laura, Yale University School of Medicine, New Haven, Connecticut, United States

Laura Aponte Becerra, MD

• Munoz Mendoza, Jair, University of Miami Miller School of Medicine, Miami, Florida, United States

Jair Munoz Mendoza, MD

• Drexler, Yelena, University of Miami Miller School of Medicine, Miami, Florida, United States

Yelena Drexler, MD, MS, FASN

• Alonso, Shawn, University of Miami Miller School of Medicine, Miami, Florida, United States

Shawn Alonso, DO

• Roth, David, University of Miami Miller School of Medicine, Miami, Florida, United States

David Roth, MD

Background

The proportion of patients with lupus approaching end-stage kidney disease (ESKD) and undergoing preemptive kidney transplantation (PKT) is <5%, due to concern for poor outcomes. In this study, we describe PKT trends in lupus versus non-lupus patients from 1985 to 2019. We also describe all-cause mortality rate in lupus and non-lupus patients undergoing PKT.

Methods

We included 3,035,161 incident ESKD patients with adequate records in the USRDS. Patients were stratified by their primary diagnosis of ESKD into 6 groups: lupus, polycystic kidney disease (PKD), glomerular diseases excluding lupus (GD), diabetes mellitus (DM), hypertension (HTN), and other diseases (OD). PKT trends were assessed with the Cochran-Armitage test.

Results

Of 33,415 lupus and 3,001,746 non-lupus incident ESKD patients, 1,234 (3.69%) and 68,326 (2.28%) underwent PKT. Lupus versus non-lupus patients undergoing PKT were younger (41 vs. 49 years), more often women (82% vs. 42%), and more frequently received living donor kidneys (64% vs. 52%). PKT trends increased from 1985 to 2019 in the lupus (3.02% to 4.65%, p=0.001), PKD (3.14 to 16.71%, p<0.001), and GD (3.94% to 5.90%, p<0.001) groups and decreased in the DM (2.11% to 0.71%, p<0.001), HTN (1.15% to 0.92%, p<0.001) and OD (3.89% to 3.60%, p<0.001) groups. Among lupus patients, PKT trends increased in those ≥ 50 years of age (1.18% to % 6.73, p<0.001), women (3.11% to 4.83%, p=0.002), Caucasian-Americans (3.78% to 5.26%, p<0.001), and Asian-Americans (0% to 10.61%, p<0.001). Among PKT patients, the mortality rate (per 100 patient-years) was similarly low in lupus (2.59), GD (2.62), PKD (2.20) and OD (2.99) patients, but significantly higher in HTN (6.39) and DM (6.49) patients.

Conclusion

In patients approaching ESKD, PKT trends have increased from 1985 to 2019 in patients with lupus, PKD and GD, most notably in PKD patients. Mortality rates are similarly low in lupus, GD, and PKD patients undergoing PKT.