Graft survival and mortality outcomes after kidney transplant in patients with lupus nephritis: a systematic review and meta-analysis

Figures & data

Figure 1. Selection process flowchart.

Table 1. Included studies.

Author (year of publication)	Study design	Country	Subject characteristics	Sample size	Newcastle Ottawa quality score
[9]	Retrospective cohort (registry data)	Multicentric (Europe)	Subjects (with or without SLE) matched for baseline characteristics; mean age at transplant ∼40 years; females (82%); majority with deceased donor (∼70%) Follow up of around 10 years No significant difference in immunosuppressive regimens between both groups Primary etiology in those without lupus nephritis (LN): glomerulonephritis (19.5%), Diabetic nephropathy (20%) and pyelonephritis (10.2%)	SLE: 999 No SLE: 4995	9
[16]	Retrospective cohort	South Korea	Mean age at transplant ∼32 years; females (75%); cadaver/deceased donor in >50%; Median post-transplant follow up of around 9.5 years Data not provided on primary etiology in those without lupus nephritis (LN).	SLE: 20 No SLE: 50	7
[15]	Retrospective cohort	Mexico	Median age at transplant ∼27 years; females (75%); majority with living donor relative (∼70%) Median post-transplant follow up of around 36 months No significant difference in immunosuppressive regimens between both groups Primary etiology in those without lupus nephritis (LN): Idiopathic glomerulonephritis (78%) and renal hypoplasia (6%)	SLE: 25 No SLE: 50	7
[28]	Case-control	Spain	Median age at transplant ∼40 years; females (35%); cadaver/deceased donor in all; Median post-transplant follow up of around 105 months Primary etiology in those without lupus nephritis (LN): primary glomerulonephritis.	SLE: 43 No SLE: 367	7
[30]	Case-control	Mexico	Median age at transplant of around 32 years; female (83%) Majority with living donor (66%); Follow up period of around 11 years. Primary etiology in those without lupus nephritis (LN): chronic glomerulonephritis, congenital urinary abnormality, polycystic kidney disease and diabetic nephropathy.	SLE: 74 No SLE: 148	8
[23]	Case-control	South America	Mean age at transplant of around 34 years; female (85%); Majority with deceased donor (>70%); Median follow up period of 90 months Data not provided on primary etiology in those without lupus nephritis (LN).	SLE: 65 No SLE: 65	7
[40]	Retrospective cohort (registry data)	Multicentric (Australia and New Zealand)	Mean age at transplant of around 40 years; female (80% in SLE and 37% in non-SLE group); Majority with deceased donor (>50%); Median follow up period of 3.8 years No significant difference in immunosuppressive regimens between both groups Data not provided on primary etiology in those without lupus nephritis (LN).	SLE: 176 No SLE: 8541	8
[24]	Retrospective cohort	South America	Mean age at transplant of around 33 years in those with SLE and 50 years in non-SLE group; female (88% in SLE and 30% in non-SLE); Majority with cadaveric donor (99%); Follow up period of around 5 years. Primary etiology in those without lupus nephritis (LN): polycystic kidney disease and diabetic nephropathy.	SLE: 27 No SLE: 109	8
[25]	Case-control	Norway	Mean age at transplant of around 37 years; female (80%); Majority with living donor (>50%); Follow up period of >10 years No significant difference in immunosuppressive regimens between both groups Primary etiology in those without lupus nephritis (LN): membranoproliferative glomerulonephritis; IgA nephropathy and focal segmental glomerulosclerosis	SLE: 77 No SLE: 154	8
[38]	Case-control	Taiwan	Mean age at transplant of around 34 years; female (>70%); Majority deceased donor (>90%); Mean follow up period of 107 months No significant difference in immunosuppressive regimens between both groups Data not provided on primary etiology in those without lupus nephritis (LN).	SLE: 23 No SLE: 94	8
[19]	Case-control	Greece	Mean age at transplant of around 35 years; female (89%); Majority living donor (54%); Mean follow up period of 80 months Primary etiology in those without lupus nephritis (LN): chronic glomerulonephritis (35%); chronic pyelonephritis (21%); polycystic kidney disease (14%) and reflux nephropathy (14%).	SLE: 26 No SLE: 26	7
[6]	Retrospective cohort	United States	Mean age of around 43 years; female (40%); Majority deceased donor (75%); Mean follow up period of 4.7 years No significant difference in immunosuppressive regimens between both groups Primary etiology in those without lupus nephritis (LN): glomerulonephritis (26%); diabetic nephropathy (25%) and hypertensive nephropathy (17%).	SLE: 2886 No SLE: 89,958	8
[5]	Retrospective cohort	United States	Majority of the subjects were aged 22 to 60 years (∼80%); females (∼40%); Both cadaver/deceased donor and living donor; Follow up of 5 years No significant difference in immunosuppressive regimens between both groups Data not provided on primary etiology in those without lupus nephritis (LN).	Cadaveric donor SLE: 1170 No SLE: 42,651 Living donor SLE: 789 No SLE: 21,228	8
[21]	Case-control	Italy	Mean age at transplant of around 36 years; female (80%) Majority with cadaveric donor (80%); Follow up period of around 90 months. Primary etiology in those without lupus nephritis (LN): membranoproliferative glomerulonephritis; IgA nephropathy, hypertensive nephropathy, polycystic kidney disease and focal segmental glomerulosclerosis	SLE: 33 No SLE: 70	7
[8]	Case-control	Netherlands	Mean age at transplant of around 35 years; female (90%) Majority with cadaveric donor (83%); Follow up period of around 80 months. Primary etiology in those without lupus nephritis (LN): chronic pyelonephritis, hemolytic uremic syndrome, membranoproliferative glomerulonephritis; IgA nephropathy, interstitial nephritis, nephropathy and polycystic kidney disease	SLE: 23 No SLE: 23	7

Figure 2. Patient survival.

Table 2. Subgroup analysis.

	Overall patient survival	Graft survival
	HR (95% Confidence interval) (N; I^2)
Sample size
≤200	0.93 (0.53, 1.62) (N = 7; I^2=0.0%)	1.28 (0.96, 1.72) (N = 8; I^2=0.0%)
>200	1.18 (1.01, 1.37) (N = 8; I^2=61.1%) *	1.05 (1.01, 1.11) (N = 8; I^2=0.0%) *
Study design
Retrospective cohort	1.10 (0.93, 1.30) (N = 7; I^2=61.6%)	1.06 (1.01, 1.12) (N = 8; I^2=0.0%) *
Case-control	1.40 (1.06, 1.85) (N = 8; I^2=0.0%) *	1.01 (0.83, 1.24) (N = 8; I^2=0.0%)

*Statistically significant at p < 0.05.

Figure 3. Graft survival.

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