According to research performed at Johns Hopkins School of Medicine and Bloomberg School of Public Health in Baltimore, Maryland, patients with kidney failure secondary to sickle cell disease are less likely to receive kidney transplants than patients with chronic kidney disease from other causes, even when registered for a kidney transplant.
Although patients with sickle cell disease and kidney failure have lowered mortality after kidney transplantation, the belief that patients with other chronic kidney disease etiologies have better outcomes makes transplantation for patients with sickle cell disease controversial.
A study of the national registry quantified a decrease in mortality associated with kidney transplantation in patients with sickle cell disease and compared this decrease with the decrease in mortality in kidney transplant recipients with other diagnoses.
All adults with kidney failure beginning maintenance dialysis or added to the kidney dialysis waiting list between 1998 and 2017 were included. The researchers compared mortality in dialysis and transplant patients in patients with and without sickle cell disease. Of waitlisted patients, 192 of 507 patients with sickle cell disease received kidney transplants, and 243,045 of 463,298 patients without sickle cell disease received kidney transplants.
The patients with sickle cell disease were younger, ranging in age from 31 to 49 years, compared to the patients without sickle cell disease, ranging from 42 to 61 years. The group with sickle cell disease was 94% Black, compared to the group without sickle cell disease, which was 28% Black. The group with sickle cell disease was less likely to have diabetes or hypertension than the group without sickle cell disease.
The risk of mortality over the next 10 years was about 20% lower for each transplant group. Although 50% of the patients with sickle cell disease and 32% of patients without sickle cell disease experienced post-transplant mortality, the percent decrease in mortality resulting from transplantation was the same.
Although the benefits of kidney transplant were the same, the group with sickle cell disease was 27% less likely to receive kidney transplants than the group without sickle cell disease. When only patients on the waitlist were included in the analysis, the chances of patients with sickle cell disease were 38% lower.
Patients can receive kidneys directly without being waitlisted, but this is uncommon. The authors concluded that more efforts should be made to provide kidney transplantation for patients with kidney failure due to sickle cell disease .
Source: Bae, S., Johnson, M., Massie, A. B., Luo, X., Haywood, C., Lanzkron, S. M., Grams, M. E., Segev, D. L., & Purnell, T. S. (2021). Mortality and Access to Kidney Transplantation in Patients with Sickle Cell Disease–Associated Kidney Failure. Clinical Journal of the American Society of Nephrology, 16(3), 407–414. https://doi.org/10.2215/cjn.02720320