Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System

Ann Rheum Dis. 2018 Sep;77(9):1333-1338. doi: 10.1136/annrheumdis-2018-213452. Epub 2018 May 14.


Background: Renal transplantation is the optimal treatment for selected patients with end-stage renal disease (ESRD). However, the survival benefit of renal transplantation among patients with ESRD attributed to granulomatosis with polyangiitis (GPA) is unknown.

Methods: We identified patients from the United States Renal Data System with ESRD due to GPA (ESRD-GPA) between 1995 and 2014. We restricted our analysis to waitlisted subjects to evaluate the impact of transplantation on mortality. We followed patients until death or the end of follow-up. We compared the relative risk (RR) of all-cause and cause-specific mortality in patients who received a transplant versus non-transplanted patients using a pooled logistic regression model with transplantation as a time-varying exposure.

Results: During the study period, 1525 patients were waitlisted and 946 received a renal transplant. Receiving a renal transplant was associated with a 70% reduction in the risk of all-cause mortality in multivariable-adjusted analyses (RR=0.30, 95% CI 0.25 to 0.37), largely attributed to a 90% reduction in the risk of death due to cardiovascular disease (CVD) (RR=0.10, 95% 0.06-0.16).

Discussion: Renal transplantation is associated with a significant decrease in all-cause mortality among patients with ESRD attributed to GPA, largely due to a decrease in the risk of death to CVD. Prompt referral for transplantation is critical to optimise outcomes for this patient population.

Keywords: epidemiology; granulomatosis with polyangiitis; outcomes research.

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Comorbidity
  • Data Systems
  • Female
  • Follow-Up Studies
  • Granulomatosis with Polyangiitis / complications
  • Granulomatosis with Polyangiitis / mortality*
  • Humans
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / mortality*
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / mortality*
  • Male
  • Middle Aged
  • Prognosis
  • Registries
  • United States / epidemiology
  • Waiting Lists