0699: A Retrospective Comparison of Transplant Outcomes in Patients with and Without Systemic Sclerosis

Background/Purpose: Scleroderma renal crisis (SRC) is one of the life threatening complications of systemic sclerosis (SSc). Up to 20-50% require long term dialysis and subsequently kidney transplant. We performed a retrospective study using the United Network for Organ Sharing (UNOS) database, to compare graft and patient survival in kidney transplantation (KT) patients with and without systemic sclerosis. We further investigated whether different induction immunosuppression strategies had varying outcomes in above cohort.

Methods: A retrospective analysis was conducted using UNOS database from 2000 to 2022. A total of 211 patients were chosen based on diagnostic coding consistent with scleroderma related diagnoses who underwent KT from deceased donors (DD) and live donors (LD). This cohort was then matched to non-SSc recipients using a propensity score matching. Induction immunosuppressive regimens analyzed included alemtuzumab, basiliximab/daclizumab, and combinations of thymoglobulin with either basiliximab or daclizumab, using thymoglobulin alone as the reference group. Maintenance prednisone was also analyzed following KT. Graft and patient survival were compared between the SSc and matched non-SSc cohorts using hazard ratios (HR), both overall and stratified by induction regimen.

Results: There was a statically significant association with poorer outcomes in both graft and patient survival from both DD, and LD following KT in our SSc cohort when compared to non-SSc cohort (Table 1) (Figure 1). There was no statistically significant difference in graft and patient survival between the SSc and matched non-SSc cohorts across the various induction immunosuppression regimens along with maintenance prednisone (Table 2).

Conclusion: Using UNOS data from 211 SSc patients, we found statistically significant worse outcomes in both graft and patient survival when compared to matched controls in both DD and LD groups. Our findings align with prior UNOS-based studies which also reported lower graft survival rates in SSc transplant recipients. These poorer outcomes are likely multifactorial, potentially driven by SRC recurrence and multi-organ involvement. The use of different induction methods along with maintenance prednisone had no statistically significant difference in graft and patient outcomes when compared to our non-SSc cohort.