Abstract 702: Renal Graft Survival and Patient Mortality in Wegener’s Granulomatosis (WG): A Case/Control Study
Phil Seo
Authors
C. L. Koening, C. A. Langford, H. L. Kirchner, A. O'Connor, E. Poggio, E. R. Mcfadden, G. S. Hoffman
Background
Wegener’s granulomatosis is an autoimmune disease characterized by the presence of a vasculitis that affects the small- and medium- caliber blood vessels. Patients with severe Wegener’s granulomatosis can develop a rapidly progressive glomerulonephritis that can quickly lead to end stage renal disease. Although dialysis is a life-saving therapy, we know that patients with end-stage renal disease who undergo renal transplant generally fare even better. This study examined outcomes among patients with Wegener’s granulomatosis, and compared those outcomes to those experienced by patients who received renal transplant for other indications.
Methods
Patients with Wegener’s granulomatosis who had received renal transplantation were identified by using the United States Renal System (USRDS) database. Each patient was matched to two control patients who had received renal transplant for another indication (predominantly diabetes-related renal failure). Matching criteria included age, gender, race, and transplant characteristics.
Results
Using the USRDS, 712 patients with Wegener’s granulomatosis who had received a renal transplant were identified; these patients were matched to 1424 control patients. The graft failure rate was slightly lower among patients with Wegener’s granulomatosis than among controls (22% versus 26%, P=0.04). The most common cause of graft failure was chronic rejection; recurrent kidney disease was surprisingly low in both groups (4.4%). The 5 year kidney survival for patients with Wegener’s granulomatosis who had received a renal transplant was 86.9% (95% CI: 84.2-89.2), which was comparable to the renal survival among patients in the control population. All-cause mortality was also slightly lower among patients with Wegener’s granulomatosis than among control patients (19% versus 25%, P=0.002). The most common cause of death among patients with Wegener’s granulomatosis was infection (21%). The 5-year survival for patients with WG in this study was 89.9% (95% CI 87-4-91.9), which was not statistically different from the 5-year survival among the control population.
Conclusions
Patients with end-stage renal disease from Wegener’s granulomatosis who undergo renal transplant fare at least as well as patients who undergo renal transplant for other causes. Disease recurrence was a relatively uncommon cause of graft loss among these patients.
Editorial Comment
As the prognosis of patients with Wegener’s granulomatosis continues to improve, our attention must increasingly turn towards the long-term needs of our patients, including the need for renal replacement therapy. Some nephrologists have been reluctant to recommend renal transplant for patients with Wegener’s granulomatosis because the effects of vasculitis on the transplanted kidney have not been clear. This work demonstrates that the outcomes associated with renal transplantation among patients with Wegener’s granulomatosis are excellent. It is important to note that the control population in this study is quite heterogeneous, and may include at least some patients who were diagnosed with “idiopathic” renal failure, although this is unlikely to have significantly affected the results of this study.
