Timely renal transplantation for scleroderma end-stage kidney disease patients can improve outcomes and quality of life

Indication for and timing of renal transplantation for systemic sclerosis (SSc) patients who require renal replacement therapy (RRT) as a result of scleroderma end-stage kidney disease (ESKD) is controversial. We recently published a review of scleroderma renal crisis (SRC) and renal involvement in SSc that included an examination of outcomes of RRT, and the role and timing of renal transplantation in SSc patients who become dialysis-dependent as result of ESKD (1). In our review of 10 articles published between 1990 and 2015 the vast majority of patients experienced SRC, with 1–5% of patients found to have ANCA-associated vasculitis or microangiopathic hemolytic anemia (1). These articles describe the onset and clinical course of SSc-associated renal failure, including issues with dialysis outcomes related to vascular access and poor tolerability of dialysis procedures—peritoneal and hemodialysis; four additional publications described results of renal transplantation in the context of a practice of delaying transplant until it was certain that renal function would not recover (2-5). This approach was thought to be supported by observations of research groups in USA, France and UK that up to 25% of SRC ESKD patients recovered renal function within a year on dialysis (6-9)