Kidney Transplantation Improves Survival in Antineutrophil Cytoplasmic Antibody-Associated Vasculitides With End-Stage Kidney Disease.

Introduction: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) frequently leads to end-stage kidney disease (ESKD). Although kidney transplantation (KT) is considered the optimal treatment for ESKD, its survival benefit in patients with AAV remains understudied. This study aimed to determine the impact of KT on survival in waitlisted patients with AAV-induced ESKD (AAV-ESKD).

Methods: We conducted a retrospective analysis of patients with AAV-ESKD registered in the French Renal Epidemiology and Information Network (REIN) registry and waitlisted for KT between 2002 and 2022. KT was treated as a time-dependent variable to avoid immortal time bias. Survival was assessed using Kaplan-Meier analysis and Cox proportional hazards models, adjusting for key demographic and clinical factors. Subgroup analyses were conducted based on vasculitis type, age, sex, and year of ESKD onset.

Results: Of 1165 patients with AAV-ESKD, 468 (40%) were waitlisted, and 318 of these (68%) received a transplant. After a median follow-up of 61 months after waitlisting, KT was associated with a 53% reduction in mortality risk (adjusted hazard ratio [HR] = 0.47 [0.31-0.73], < 0.001). This benefit was consistent across subgroups. Patient survival at 10 years was 72% for transplant recipients versus 28% for nontransplanted patients ( < 0.001). Sensitivity analyses, after excluding recipients of living donors and patients removed from the waitlist supported the robustness of these findings. Within 2 years from ESKD onset, 24% of waitlisted patients were transplanted. Graft failure probability was 22% at 10 years posttransplant.

Conclusion: KT is associated with a significant survival benefit in waitlisted patients with AAV-ESKD compared with waiting on dialysis. These findings emphasize the importance of timely transplant evaluation and improved access to KT for this population.