Racial, Ethnic and Sex Disparities in Lupus Patients With Kidney Transplant: A UNOS Database Analysis

Area of Science:

• Nephrology
• Transplantation Immunology
• Health Disparities Research

Background:

• Lupus nephritis disproportionately impacts women and Black individuals.
• Kidney transplantation is the optimal treatment for end-stage kidney disease due to lupus nephritis.
• Existing research indicates potential disparities in transplant outcomes based on sex and race.

Purpose of the Study:

• To investigate post-kidney transplant outcomes in lupus nephritis recipients.
• To analyze differences in graft failure and mortality stratified by sex and race/ethnicity.
• To determine if disparities observed pre-transplant persist after kidney transplantation.

Main Methods:

• Retrospective analysis of the United Network for Organ Sharing database (2010-2024).
• Inclusion of kidney transplant recipients with systemic lupus erythematosus as the primary diagnosis.
• Assessment of donor/recipient characteristics, graft failure, and mortality using Kaplan-Meier curves and Cox regression.

Main Results:

• Male sex was associated with increased graft failure (HR 1.20) and mortality (HR 1.30).
• Black recipients experienced the highest graft failure rate (22.4%).
• Black race correlated with higher mortality odds in deceased donor kidney transplants (HR 1.60 for lupus).

Conclusions:

• Male sex and Black race are associated with poorer outcomes, including graft loss and mortality, in kidney transplant recipients with lupus nephritis.
• These findings highlight persistent disparities in transplant care and outcomes for specific demographic groups.
• Further research is needed to address access and outcome discrepancies in lupus nephritis patients undergoing kidney transplantation.