Kidney Transplantation Improves Survival in Lupus Nephritis With End-Stage Kidney Disease

Introduction: Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE) and is associated with high morbidity and mortality rates. Although kidney transplantation (KT) is considered the optimal treatment for end-stage kidney disease (ESKD), its survival benefit, specifically in patients with LN-induced ESKD (LN-ESKD), is not well-established. This study aimed to determine the effects of KT on the survival of a national cohort of patients with LN-ESKD. Methods: We retrospectively analyzed patients with LN-ESKD registered in the French Renal Epidemiology and Information Network (REIN) registry, who were waitlisted for KT between 2002 and 2022. KT was treated as a time-dependent variable to avoid an immortal time bias. The primary outcome was all-cause mortality, which was assessed using Kaplan-Meier analysis and adjusted Cox proportional hazards models. Sensitivity analyses, after excluding recipients of living donors and patients who were inactivated from the waitlist, supported these findings. Two years after the onset of ESKD, 38% of the waitlisted patients under went transplantation. The probability of graft failure was 23% at 10 years posttransplant. Conclusion: Compared with patients who remain on dialysis, KT is associated with improved survival in patients with LN-ESKD. Early evaluation of transplant eligibility and timely referral to transplant centers are crucial for optimizing outcomes.