Renal transplantation reduces risk of CV events in patients of ANCA-associated vasculitis and ESRD

The researchers identified patients from the United States Renal Data System with end-stage renal disease (ESRD) due to ANCA-associated vasculitis (AAV) between 2000 and 2016. They examined the association between renal transplantation and the risk of non-fatal and fatal myocardial infarction or ischemic stroke among waitlisted patients using Medicare claims and death data through 2017. They used time-varying Cox proportional hazards models with age as the time scale to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for myocardial infarction and ischemic stroke events among patients who received a renal transplant compared to those who remained on the waitlist.

Results of the study are:

Of 1029 waitlisted patients, 593 (58%) were transplanted over a mean of 5.7 years. There were 17 events (4.6/1,000 person-years) in the transplanted group and 40 events (13.7/1,000 person-years) in the group that remained waitlisted. A renal transplant was associated with a 78% lower risk of myocardial infarction or ischemic stroke (HR=0.22, 95% CI 0.11 to 0.47). These findings persisted across sex and age groups and when censoring patients after living donor transplantation.

Thus, the researchers concluded that among ANCA-associated vasculitis (AAV) patients with end-stage renal disease (ESRD), renal transplantation can substantially reduce the risk of myocardial infarction and ischemic stroke. Improving access to transplantation for this population may further improve outcomes.

Reference:

Association of renal transplantation with reduced risk of myocardial infarction and ischemic stroke in ANCA-associated vasculitis: An observational cohort study by Claire Cook et al. published in the Seminars in Arthritis and Rheumatism.

https://www.sciencedirect.com/science/article/abs/pii/S0049017221001888