Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000-2019 UNOS/OPTN Database.

Napat Leeaphorn,Michael A Mao,Panupong Hansrivijit,Wisit Kaewput,Shennen A Mao,Caroline C Jadlowiec,Sreelatha Katari,Charat Thongprayoon,Wisit Cheungpasitporn,Boonphiphop Boonpheng,Matthew Cooper,Pattharawin Pattharanitima,Api Chewcharat,Pradeep Vaitla

doi:10.3390/jcm10143063

Abstract

Background: Lower patient survival has been observed in sickle cell disease (SCD) patients who go on to receive a kidney transplant. This study aimed to assess the post-transplant outcomes of SCD kidney transplant recipients in the contemporary era. Methods: We used the OPTN/UNOS database to identify first-time kidney transplant recipients from 2010 through 2019. We compared patient and allograft survival between recipients with SCD (n = 105) vs. all other diagnoses (non-SCD, n = 146,325) as the reported cause of end-stage kidney disease. We examined whether post-transplant outcomes improved among SCD in the recent era (2010–2019), compared to the early era (2000–2009). Results: After adjusting for differences in baseline characteristics, SCD was significantly associated with lower patient survival (HR 2.87; 95% CI 1.75–4.68) and death-censored graft survival (HR 1.98; 95% CI 1.30–3.01), compared to non-SCD recipients. The lower patient survival and death-censored graft survival in SCD recipients were consistently observed in comparison to outcomes of recipients with diabetes, glomerular disease, and hypertension as the cause of end-stage kidney disease. There was no significant difference in death censored graft survival (HR 0.99; 95% CI 0.51–1.73, p = 0.98) and patient survival (HR 0.93; 95% CI 0.50–1.74, p = 0.82) of SCD recipients in the recent versus early era. Conclusions: Patient and allograft survival in SCD kidney recipients were worse than recipients with other diagnoses. Overall SCD patient and allograft outcomes in the recent era did not improve from the early era. The findings of our study should not discourage kidney transplantation for ESKD patients with SCD due to a known survival benefit of transplantation compared with remaining on dialysis. Urgent future studies are needed to identify strategies to improve patient and allograft survival in SCD kidney recipients. In addition, it may be reasonable to assign risk adjustment for SCD patients.

Highlights

Sickle cell disease (SCD) is the most common inherited blood disorder in the UnitedStates, affecting approximately 100,000 Americans [1,2,3,4]
Patient and allograft survival between recipients with sickle cell disease (SCD) end stage kidney disease (ESKD) were compared to recipients with all other diagnoses
SCD was significantly associated with lower death-censored graft survival compared to diabetes mellitus (DM) (HR 2.32; 95% confidence interval (95% CI) 1.52–3.56, p < 0.001), glomerular disease

Summary

Introduction

Sickle cell disease (SCD) is the most common inherited blood disorder in the UnitedStates, affecting approximately 100,000 Americans [1,2,3,4]. Despite having an increased risk, SCD ESKD patients receive a survival benefit following kidney transplantation similar to non-SCD ESKD patients [8,9]. Despite improvement in survival after transplantation in SCD patients [8,9], there are still concerns regarding worse outcomes among kidney transplant recipients with SCD compared to non-SCD recipients [8,10]. Lower patient survival has been observed in sickle cell disease (SCD) patients who go on to receive a kidney transplant. We compared patient and allograft survival between recipients with SCD (n = 105) vs all other diagnoses (non-SCD, n = 146,325) as the reported cause of end-stage kidney disease. We examined whether post-transplant outcomes improved among SCD in the recent era (2010–2019), compared to the early era (2000–2009)

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