Renal transplantation in end-stage sickle cell nephropathy

Transplantation. 1999 Jan 27;67(2):291-5. doi: 10.1097/00007890-199901270-00018.

Abstract

Background: The role of renal transplantation as treatment for end-stage sickle cell nephropathy (SCN) has not been well established.

Methods: We performed a comparative investigation of patient and allograft outcomes among age-matched African-American kidney transplant recipients with ESRD as a result of SCN (n=82) and all other causes (Other-ESRD, n=22,565).

Results: The incidence of delayed graft function and predischarge acute rejection in SCN group (24% and 26%) was similar to that observed in the Other-ESRD group (29% and 27%). The mean discharge serum creatinine (SCr) was 2.7 (+/-2.5) mg/dl in the SCN recipients compared to 3.0 (+/-2.5) mg/dl in the Other-ESRD recipients (P=0.42). There was no difference in the 1-year cadaveric graft survival (SCN: 78% vs. Other-ESRD: 77%), and the multivariable adjusted 1-year risk of graft loss indicated no significant effect of SCN (relative risk [RR]=1.39, P=0.149). However, the 3-year cadaveric graft survival tended to be lower in the SCN group (48% vs. 60%, P=0.055) and their adjusted 3-year risk of graft loss was significantly greater (RR= 1.60, P=0.003). There was a trend toward improved survival in the SCN transplant recipients compared to their dialysis-treated, wait-listed counterparts (RR=0.14, P=0.056). In comparison to the Other-ESRD (RR=1.00), the adjusted mortality risk in the SCN group was higher both at 1 year (RR=2.95, P=0.001) and at 3 years (RR=2.82, P=0.0001) after renal transplantation.

Conclusions: The short-term renal allograft result in recipients with end-stage SCN was similar to that obtained in other causes of ESRD, but the long-term outcome was comparatively diminished. There was a trend toward better patient survival with renal transplantation relative to dialysis in end-stage SCN.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • African Americans
  • African Continental Ancestry Group
  • Anemia, Sickle Cell / complications*
  • Child
  • Cohort Studies
  • Female
  • Graft Survival*
  • Histocompatibility Testing
  • Humans
  • Kidney Failure, Chronic / etiology*
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / mortality
  • Kidney Transplantation / physiology*
  • Male
  • Middle Aged
  • Risk Factors
  • Survival Analysis
  • Time Factors
  • Tissue Donors
  • Treatment Outcome
  • United States