L KUHNEL1, N MAIZELS1, C HAWLEY1,2, D JOHNSON1,2, G GOBE1, R FRANCIS1,2, R ELLIS1,2
1Faculty of Medicine, University of Queensland, Brisbane, Australia, 2Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
Aim: To evaluate rates of allograft failure compared by aetiology of kidney disease.
Background: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides such as granulomatosis and polyangiitis (Wegener’s granulomatosis) and microscopic polyangiitis are uncommon causes of kidney failure in Australia and New Zealand. Kidney transplant recipients who developed kidney failure secondary to ANCA-associated vasculitis are unlikely to experience disease recurrence, and typically have good immunological outcomes.
Methods: All 18,901 kidney transplant recipients aged over 18 years who were undergoing their first kidney transplant between January 1990 and December 2018 were ascertained from the ANZDATA Registry. Cox proportional hazards models were used to compare rates of all-cause and death-censored allograft failure between aetiologies of kidney disease.
Results: Of 254 participants whose primary disease was ANCA-associated vasculitis, 95 (37%) developed allograft failure, and 62 (65%) cases were due to death with a functioning allograft. When compared with patients with IgA nephropathy, those with ANCA-associated vasculitis had significantly higher rates of all-cause allograft failure (HR: 1.4, 95%CI: 1.2-1.7), and higher rates compared with most other glomerular diseases; however, rates of death-censored allograft failure were similar (HR: 1.0, 95%CI: 0.7-1.4). The most frequent causes of death in the ANCA-vasculitis group who died with a functioning graft were infection (23%) and malignancy (36%).”
Conclusions: These results indicate that kidney transplant recipients whose primary kidney disease was ANCA-associated vasculitis have higher rates of death with a functioning allograft compared with most other glomerular diseases. Causes of death in these patients were predominantly related to consequences of immunosuppression. Rationalisation of immunosuppression in this patient group may improve outcomes.
Dr Robert Ellis is a resident at the Princess Alexandra Hospital and lecturer at the University of Queensland in Brisbane.