title: Kidney Transplantation Outcomes across GN Subtypes in the United States.
abstract: Differences in kidney transplantation outcomes across GN subtypes have rarely been studied. From the US Renal Data System, we identified all adult (≥18 years) first kidney transplant recipients (1996-2011) with ESRD attributed to one of six GN subtypes or two comparator kidney diseases. We computed hazard ratios (HRs) for death, all-cause allograft failure, and allograft failure excluding death as a cause (competing risks framework) using Cox proportional hazards regression. Among the 32,131 patients with GN studied, patients with IgA nephropathy (IgAN) had the lowest mortality rates and patients with IgAN or vasculitis had the lowest allograft failure rates. After adjusting for patient- and transplant-related factors, compared with IgAN (referent), FSGS, membranous nephropathy, membranoproliferative GN, lupus nephritis, and vasculitis associated with HRs (95% confidence intervals) for death of 1.57 (1.43 to 1.72), 1.52 (1.34 to 1.72), 1.76 (1.55 to 2.01), 1.82 (1.63 to 2.02), and 1.56 (1.34 to 1.81), respectively, and with HRs for allograft failure excluding death as a cause of 1.20 (1.12 to 1.28), 1.27 (1.14 to 1.41), 1.50 (1.36 to 1.66), 1.11 (1.02 to 1.20), and 0.94 (0.81 to 1.09), respectively. Considering external comparator groups, and comparing with IgAN, autosomal dominant polycystic kidney disease (ADPKD) and diabetic nephropathy associated with higher HRs for mortality [1.22 (1.12 to 1.34) and 2.57 (2.35 to 2.82), respectively], but ADPKD associated with a lower HR for allograft failure excluding death as a cause [0.85 (0.79 to 0.91)]. Reasons for differential outcomes by GN subtype and cause of ESRD should be examined in future research.
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and moshaugh@stanford.edu.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: O'Shaughnessy
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Sai
authors.initials: S
authors.lastname: Liu
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Montez-Rath
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Lenihan
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Lafayette
authors.affiliation: Section of Nephrology, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005921:Glomerulonephritis / Q000145:classification* / Q000150:complications* / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
keywords: chronic allograft failure; clinical epidemiology; glomerulonephritis; kidney transplantation; mortality