Brilland Benoît, Augusto Jean-François, Michel Pierre-Antoine, Jourde-Chiche Noémie, Couchoud Cécile
Service de Néphrologie-Dialyse-Transplantation, CHU Angers, Angers, France.
Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers, Inserm, CNRS, Univsité Angers, Nantes Université, SFR ICAT, Nantes, France.
Kidney Int Rep. 2025 Feb 3;10(4):1163-1174. doi: 10.1016/j.ekir.2025.01.034. eCollection 2025 Apr.
Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE) and is associated with high morbidity and mortality rates. Although kidney transplantation (KT) is considered the optimal treatment for end-stage kidney disease (ESKD), its survival benefit, specifically in patients with LN-induced ESKD (LN-ESKD), is not well-established. This study aimed to determine the effects of KT on the survival of a national cohort of patients with LN-ESKD.
We retrospectively analyzed patients with LN-ESKD registered in the French Renal Epidemiology and Information Network (REIN) registry, who were waitlisted for KT between 2002 and 2022. KT was treated as a time-dependent variable to avoid an immortal time bias. The primary outcome was all-cause mortality, which was assessed using Kaplan-Meier analysis and adjusted Cox proportional hazards models.
Of the 882 patients with LN-ESKD, 636 (72%) were waitlisted for KT, and 470 (74%) received a transplant. After a median follow-up of 80 months, KT was associated with a 60% reduction in the risk of death compared with remaining on dialysis (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.240-0.67, < 0.001), with consistent benefits across subgroups. Patient survival at 10 years was 83% for transplant recipients and 60% for nontransplant recipients ( < 0.001). Sensitivity analyses, after excluding recipients of living donors and patients who were inactivated from the waitlist, supported these findings. Two years after the onset of ESKD, 38% of the waitlisted patients under went transplantation. The probability of graft failure was 23% at 10 years posttransplant.
Compared with patients who remain on dialysis, KT is associated with improved survival in patients with LN-ESKD. Early evaluation of transplant eligibility and timely referral to transplant centers are crucial for optimizing outcomes.
狼疮性肾炎（LN）是系统性红斑狼疮（SLE）的一种严重并发症，与高发病率和死亡率相关。尽管肾移植（KT）被认为是终末期肾病（ESKD）的最佳治疗方法，但其生存获益，特别是在LN所致ESKD（LN-ESKD）患者中的生存获益尚未明确。本研究旨在确定KT对一组全国性LN-ESKD患者生存的影响。
我们回顾性分析了在法国肾脏流行病学和信息网络（REIN）登记处登记的LN-ESKD患者，这些患者在2002年至2022年期间被列入KT等待名单。KT被视为一个随时间变化的变量，以避免不朽时间偏倚。主要结局是全因死亡率，采用Kaplan-Meier分析和校正的Cox比例风险模型进行评估。
在882例LN-ESKD患者中，636例（72%）被列入KT等待名单，470例（74%）接受了移植。中位随访80个月后，与继续透析相比，KT使死亡风险降低了60%（风险比[HR]：0.40，95%置信区间[CI]：0.240-0.67，P<0.001），各亚组均有一致的获益。移植受者10年的患者生存率为83%，未移植受者为60%（P<0.001）。排除活体供者受者和从等待名单中退出的患者后的敏感性分析支持了这些发现。ESKD发病两年后，38%的等待名单上的患者接受了移植。移植后10年移植物失败的概率为23%。
与继续透析的患者相比，KT可改善LN-ESKD患者的生存。早期评估移植资格并及时转诊至移植中心对于优化结局至关重要。
