Macrae KOZODY, Jorge ORTIZ, Shriya ENDLAW, Meng-Hao LI, Yang YU, Naoru KOIZUMI, Giovanni FADDOUL
Experimental and Clinical Transplantation - 2026;24(3):210-219
Objectives: Lupus nephritis disproportionately affects women and the Black population. Kidney transplantation is the gold standard treatment for patients who progress to end-stage kidney disease. We investigated whether disparities continue after transplant, through analysis of differences in outcomes in lupus kidney recipients stratified by sex and by race and ethnicity. Materials and Methods: We conducted a retrospective United Network for Organ Sharing database analysis (January 1, 2010, through December 31, 2024) to include kidney transplant recipients with systemic lupus erythematosus as the primary diagnosis. We assessed donor and recipient characteristics, graft failure, and mortality by sex and by race and ethnicity and analyzed data with Kaplan-Meier survival curves and multivariate Cox regression. Results: Of the 8726 transplants with a lupus nephritis etiology, 81.7% were female patients (n = 7133), with racial composition of 41.7% Black, 25.3% non-Hispanic White, 23.1% Hispanic, and 7.7% Asian. Lupus nephritis 1-year graft failure rate was 10.2% (n = 893/8718) and 1-year mortality was 8.7% (n = 760/8726). Male sex correlated with higher graft failure (hazard ratio 1.20; P = .018) and mortality (hazard ratio 1.30; P = .009). Graft failure was highest among Black recipients (22.4%). Mortality was highest in non-Hispanic White (11.7%) and Black recipients (11.0%). Black race correlated with higher odds of death in both lupus (hazard ratio 1.60) and non-lupus (hazard ratio 1.14) deceased donor kidney transplants. Conclusions: Male sex correlated with increased death and graft loss in deceased donor kidney transplant recipients. These outcomes were also worse among the Black population, with higher odds of death in the lupus group compared with the group without lupus. Additional investigation is required to understand the discrepancies in access to transplant and outcomes in relation to lupus.
