Renal transplantation in end-stage sickle cell nephropathy

Background. The role of renal transplantation as treatment for end-stage si ckle cell nephropathy (SCN) has not been well established. Methods. We performed a comparative investigation of patient and allograft outcomes among age-matched African-American kidney transplant recipients wi th ESRD as a result of SCN (n=82) and all other causes (Other-ESRD, n=22,56 5). Results. The incidence of delayed graft function and predischarge acute rej ection in SCN group (24% and 26%) was similar to that observed in the Other -ESRD group (29% and 27%). The mean discharge serum creatinine (SCr) was 2. 7 (+/- 2.5) mg/dl in the SCN recipients compared to 3.0 (+/- 2.5) mg/dl in the Other-ESRD recipients (P=0.42). There was no difference in the 1-year c adaveric graft survival (SCN: 78% vs. Other-ESRD: 77%), and the multivariab le adjusted 1-year risk of graft loss indicated no significant effect of SC N (relative risk [RR]=1.39, P=0.149). However, the 3-year cadaveric graft s urvival tended to be lower in the SCN group (48% vs. 60%, P=0.055) and thei r adjusted 3-year risk of graft loss was significantly greater (RR=1.60, P= 0.003). There was a trend toward improved survival in the SCN transplant re cipients compared to their dialysis-treated, wait-listed counterparts (RR=0 .14, P=0.056). In comparison to the Other-ESRD (RR=1.00), the adjusted mort ality risk in the SCN group was higher both at 1 year (RR=2.95, P=0.001) an d at 3 years (RR=2.82, P=0.0001) after renal transplantation. Conclusions. The short-term renal allograft result in recipients with end-s tage SCN was similar to that obtained in other causes of ESRD, but the long -term outcome was comparatively diminished. There was a trend toward better patient survival with renal transplantation relative to dialysis in end-st age SCN.