Patients With Sickle-Cell Disease Less Likely To Receive Needed Kidney Transplants: Study

While individuals with kidney failure associated with sickle cell disease disease have high death rates, which can be reduced with kidney transplants, the findings of a new study suggests these patients are less likely to get the much needed kidney transplants compared to individuals with kidney failure who do not have sickle cell disease.

Sickle cell disease is an inherited group of disorders that affect red blood cells that deliver oxygen throughout the body, often impacting black individuals. However, researchers from Johns Hopkins School of Medicine indicate patients with sickle cell disease-associated kidney failure do not receive kidney transplants at the same rates as individuals with other causes.

In findings published in the February issue of the Clinical Journal of the American Society of Nephrology, researchers examined data from a national registry and studied all adults with kidney failure who began maintenance dialysis or were added to the kidney transplant waiting list from 1998 to 2017. The study focused on the absolute risk of death in matched pairs of transplant recipients compared to patients on the waitlist for kidney transplant who had sickle cell disease and control groups.

Compared to the waitlisted candidates, 189 transplant recipients with sickle cell disease and 220,000 control patients showed significantly decreased mortality.

Patients who underwent kidney transplant were 20% more likely to survive 10 more years than those who stayed on the waiting list and did not receive the transplant. That included patients who had kidney transplants who also had sickle cell-related kidney failure.

Overall, the patients with sickle cell disease, despite needing necessary kidney transplants, were less likely to receive transplants than control patients.

Sickle cell disease can lead to impaired blood flow, infections, chest syndrome and stroke. While the disease can occur in any race, it is more common among African Americans. Roughly 1 out of every 365 African Americans will have sickle cell disease, compared to one out of every 1,500 white or Hispanic Americans.

Sickle cell disease is a risk factor for kidney disease and adults with sickle cell-related kidney failure on long-term dialysis have a high risk of early death. The risk can be reduced with a kidney transplant, but those patients often do not receive the needed transplants compared to patients who don’t have sickle cell disease.

The findings indicate patients who have sickle cell disease are nearly 30% less likely to receive a kidney transplant than patients who don’t have sickle cell disease. When focusing only on patients who were added to the kidney transplant waiting list, those with sickle cell disease are 38% less likely to receive a transplant than other patients.

“Patients with sickle cell disease–associated kidney failure exhibited similar decreases in mortality associated with kidney transplantation as compared with those with other kidney failure etiologies,” wrote study authors. “Nonetheless, the sickle cell population was less likely to receive transplantation, even after waitlist registration.”