Outcomes of Kidney Transplantation in Scleroderma Patients: A U.S. National Database Study

Background Scleroderma is a systemic autoimmune disease that can progress to end-stage renal disease. Historically, kidney transplantation in scleroderma patients was associated with poor outcomes, but contemporary results in the United States remain understudied. Methods Adult kidney transplant recipients with scleroderma (1990-2020) were identified from the SRTR database. Control groups included patients with diabetes mellitus, IgA nephropathy, and all non-scleroderma recipients. Kaplan-Meier methods were used to estimate patient survival and graft survival. Results Among 347,598 kidney transplant recipients, 399 had scleroderma. Compared with non-scleroderma recipients, those with scleroderma were more likely to receive a living donor transplant (45.1% vs. 34.3%, p<0.001), be female (77.9% vs. 39.3%, p<0.001), be white (86.5% vs. 66.8%, p<0.001), and have a lower body mass index (22.9 vs. 27.1 kg/m², p<0.001). After adjustment for various factors, scleroderma was associated with higher mortality compared with non-scleroderma recipients (HR 1.39, 95% CI 1.19–1.65) and recipients with IgA nephropathy (HR 2.98, 95% CI 2.48–3.58), but comparable to recipients with diabetes mellitus (HR 0.88, 95% CI 0.75–1.04). Death-censored graft survival was comparable between recipients with scleroderma and those with diabetes mellitus (HR 0.91, 95% CI 0.69–1.19) or non-scleroderma recipients (HR 1.27, 95% CI 0.97–1.67), but was inferior compared with recipients with IgA nephropathy (HR 2.11, 95% CI 1.59–2.80). Conclusion Outcomes of kidney transplantation in scleroderma patients are similar to patients with diabetes but inferior to patients with IgA nephropathy and kidney transplant is a viable option for scleroderma patients with end stage kidney disease.