People with kidney failure related to sickle cell disease are less likely to receive a transplant than those without sickle cell disease, but it could be life-saving for them, a new study finds.
Sickle cell disease is a risk factor for kidney failure, and adults with sickle cell-related kidney failure who are on long-term dialysis have high rates of early death.
Kidney transplant is another option, but it wasn’t clear if it would lower these patients’ risk of premature death.
To find out, researchers examined data on all U.S. adults with kidney failure who began dialysis or were added to the kidney transplant waiting list from 1998 to 2017.
Patients who had a kidney transplant — including those with sickle cell-related kidney failure — were about 20% more likely to survive over 10 years than those who remained on the waiting list, according to the study. The results were published Feb. 25 in the Clinical Journal of the American Society of Nephrology.
“Our study findings lend strong support to the viewpoint that transplantation is a valuable treatment option for patients with sickle cell-associated kidney failure,” study co-leader Sunjae Bae said in a journal news release. Bae is with Johns Hopkins University, in Baltimore.
But the researchers also found that kidney failure patients with sickle cell disease were 27% less likely to have a kidney transplant than patients without the disease.
And when the analysis was limited to patients added to the kidney transplant waiting list, those with sickle cell disease were 38% less likely to receive a transplant than other patients.
“Previously, some providers who relied upon older data expressed concerns that transplantation may be rather futile in the sickle cell population given their relatively high mortality rate after transplantation. On the other hand, the sickle cell population also shows extremely high mortality while on dialysis,” Bae said.
“Therefore, if their post-transplant mortality is still sufficiently lower than their dialysis mortality, kidney transplantation could be a preferable treatment option in the sickle cell population,” according to Bae.
Study co-author Tanjala Purnell, also of Johns Hopkins, said the study demonstrates better survival with transplant for these patients.
“As a field, we must do a better job of improving access to transplantation for patients with sickle cell disease,” Purnell said. “We must eliminate disparities in access to this life-saving procedure.”
The U.S. National Heart, Lung, and Blood Institute has more on sickle cell disease.
SOURCE: Clinical Journal of the American Society of Nephrology, news release, Feb. 25, 2021