Access to renal transplantation among patients with end-stage renal disease due to lupus nephritis

Abstract

Access to living related renal and cadaveric renal transplantation was compared between 5,863 adults with incident end-stage renal disease (ESRD) caused by lupus nephritis and 463,141 adults with other causes of ESRD who were included in the US Renal Data System from 1987 to 1995. Using Cox regression models that adjusted for differences in age, sex, race, region of residence, and year of onset of ESRD, patients with ESRD caused by lupus nephritis were as likely as patients with other causes of ESRD to receive a living related renal transplant (adjusted hazard ratio [HR] = 1.02; 95% confidence interval [CI], 0.93 to 1.10; P = 0.70) but were 20% less likely to receive a cadaveric renal transplant (adjusted HR = 0.80; 95% CI, 0.75 to 0.85; P < 0.0001). Patients with ESRD caused by lupus nephritis were significantly more likely to be entered onto a waiting list for cadaveric renal transplantation (adjusted HR = 1.15; 95% CI, 1.10 to 1.21; P < 0.0001) but were less likely to receive a cadaveric transplant once entered onto a waiting list (adjusted HR = 0.73; 95% CI, 0.69 to 0.78; P < 0.0001). Patients with ESRD caused by lupus nephritis had equal access to living related renal transplantation and greater enrollment on waiting lists for cadaveric transplantation than patients with ESRD from other causes, indicating that medical ineligibility is not a major barrier to transplantation. Both medical and nonmedical factors may contribute to the decreased likelihood of cadaveric transplantation among patients with ESRD caused by lupus nephritis.