Renal transplantation: outcomes
Risk factors for graft loss in patients with recurrent IGA nephropathy after renal transplantation

https://doi.org/10.1016/j.transproceed.2004.05.044Get rights and content

Abstract

Background

The recurrence rate of IgA nephropathy (IgAN) in transplanted kidneys has been reported to be >50%. Although recurrent IgAN has a benign clinical course, recent data suggest that it leads to graft loss in a substantial number of patients.

Methods

We performed a retrospective single-center analysis of 34 renal transplant recipients, with biopsy-proven IgAN as the cause of end-stage renal failure.

Results

Renal allograft biopsies were performed in 30 patients, of whom 24 did and 6 did not have biopsy-confirmed recurrent transplant IgAN. Recurrent transplant IgAN was more often detected in men and at later timepoints after post-transplantation. Four patients with recurrent transplant IgAN progressed to graft failure. Progression to graft failure was associated with worsened renal function, higher systolic blood pressure, and the lack of presenation of angiotensin-converting enzyme inhibitors (ACEs) at the time of allograft biopsy. Immunologic factors such as frequency of acute rejection, HLA typing, and immunosuppression did not show a relation to recurrence or graft loss.

Conclusions

Recurrent transplant IgAN increased with long-term graft survival and risk factors for graft loss due to recurrent IgAN were similar to those among IgAN in native kidneys.

Section snippets

Patients and tissue samples

Among 440 renal transplants performed between 1980 and 2001, 34 displayed biopsy-proven IgAN as the cause of end-stage renal failure. We performed a retrospective analysis of these 34 renal transplant recipients. The diagnosis of recurrent IgAN was based on immunofluorescence analysis of graft biopsy showed mesangial IgA deposits. The possibility of IgAN from the donor was excluded by the negative findings in an 1-hour biopsy. Graft loss was defined as the end-stage renal failure requiring

Results

Renal allograft biopsies were performed in 30 patients among 34 renal transplant recipients who had biopsy-proven IgAN as the course of their end-stage renal failure. Twenty-four patients had biopsy-confirmed recurrent transplant IgAN and 6 patients had no evidence of the disorder. Four patients among the 24 patients with recurrent transplant IgAN progressed to graft failure.

Fig 1 shows graft survival among patients with versus without recurrence. There was no significant difference in

Discussion

This study was based on a retrospective analysis of 34 patients who underwent renal transplantation because of biopsy-proven IgAN. Recurrent IgAN after transplantation is common, being reported in 13% to 60% of patients depending on the duration of follow-up and the biopsy policy of the respective transplant center.2 In the present study we found the recurrence rate to be ≥70% (24 of 34). This recurrence rate is higher than that in previous reports. Several studies have reported a higher risk

References (8)

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Cited by (19)

  • The clinical course of IgA nephropathy after kidney transplantation and its management

    2017, Transplantation Reviews
    Citation Excerpt :

    In a retrospective analysis [75] of 48 KTx recipients, all of Chinese origin, with biopsy-proven IgAN as the cause of ESRD, 29% of the patients had biopsy-confirmed recurrent transplant IgAN, after a median follow-up of 52 months, which was associated with greater serum IgA levels. With respect to the correlation between living-related donation and risk of recurrence [53,60,74–77], Wang et al. reported a higher graft failure rate in the long term, with the use of allografts from living-related donors, in comparison with unrelated donors [78], although this observation was not confirmed by others [57,60]. However, it is important to remember that familial IgAN carries a markedly increased risk of ESRD [79] and even minor urinary findings in related donors should be clarified by renal biopsy [80].

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