Psoriasis associates with increased risk for kidney transplant rejection

Psoriasis is a common immune-mediated skin disorder with additional manifestations due to systemic inflammation. Patients with psoriasis have an increased risk of end-stage renal disease (ESRD) requiring either dialysis or renal transplant; however, the relationship between psoriasis and renal allograft failure has not been established.

We conducted a retrospective cohort study using the United States Renal Data System to analyze the association between psoriasis and graft failure (occurring more than 2 weeks after the transplant). We compared transplant failure rates in ESRD patients with a psoriasis diagnosis prior to the initial transplant versus transplanted ESRD patients without a psoriasis diagnosis. From 2004 to 2019, a total of 151 272 renal transplant patients aged 18-100 and meeting exclusion and inclusion criteria were identified; in this cohort, 1105 ESRD patients had International Classification of Diseases (ICD)-9 and -10 claim codes for psoriasis prior to their renal transplant.

Logistic regression modeling was used to examine possible confounders of psoriasis on graft failure. Kaplan-Meier estimates indicated that renal transplant patients with psoriasis had reduced graft survival over time compared with those without psoriasis. In addition, Cox proportional hazard analysis, controlling for demographics and clinical risk factors, showed a significantly increased hazard ratio for renal allograft failure for patients with a diagnosis of psoriasis.

The systemic inflammation and immune-mediated pathophysiology underlying psoriasis could underlie the association between psoriasis and the increased risk of renal transplant failure.