Outcomes After Kidney Transplantation in Antineutrophil Cytoplasmic Autoantibody-Associated Renal Vasculitis
A 12-center French study of 206 transplant recipients with ANCA-associated vasculitis found short-term graft outcomes similar to matched controls, but higher long-term risk of graft failure and death, with azathioprine maintenance and disease relapse linked to worse graft survival.
Study design
Multicenter retrospective study of 206 adults with ANCA-associated renal vasculitis and 412 matched controls who underwent kidney transplantation between 2005 and 2023 across 12 French centers, comparing delayed graft function, graft failure, relapses, acute rejection, and mortality with multivariable modeling.
Key findings
Delayed graft function and kidney function through 5 years were similar between groups, but vasculitis patients trended toward poorer graft survival (HR 1.55; P=0.077) and had significantly lower overall survival (HR 1.48; P=0.034). Vasculitis relapses occurred in 7.3% and significantly worsened graft survival, while azathioprine maintenance was associated with markedly higher rejection (HR 3.73) and graft failure (HR 3.73).
Clinical implications
Transplantation offers acceptable short-term outcomes in ANCA-associated vasculitis, but the higher long-term graft-failure and mortality risk argues for careful post-transplant monitoring including ANCA status, and for avoiding azathioprine as maintenance therapy, without unduly delaying transplantation.
Category
Transplant
Source
Kidney International Reports
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