Posttransplantation Glomerulonephritis: Risk Factors Associated With Kidney Allograft Loss

Ostrowska, J.; Pazik, J.; Lewandowski, Z.; Mróz, A.; Perkowska-Ptasińska, A.; Durlik, M.

doi:10.1016/j.transproceed.2007.08.042

« Previous Next »Transplantation Proceedings
Volume 39, Issue 9 , Pages 2751-2753, November 2007

Posttransplantation Glomerulonephritis: Risk Factors Associated With Kidney Allograft Loss

J. Ostrowska
- Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
- Address reprint requests to Joanna Ostrowska, Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Nowogrodzka 59 St, 02-006 Warszawa, Poland.
J. Pazik
- Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
Z. Lewandowski
- Department of Epidemiology, Medical University of Warsaw, Warsaw, Poland
A. Mróz
- Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
- Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education, Warsaw, Poland.
A. Perkowska-Ptasińska
- Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
M. Durlik
- Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland

Abstract

Aim of the Study

Chronic glomerulonephritis (GN) is reported as a common cause of late kidney allograft loss. The aim of this study was to identify risk factors associated with kidney allograft loss in the course of posttransplantation GN.

Patients and Methods

The study analyzed 75 kidney allograft recipients with biopsy-confirmed posttransplantation GN, including 27 cases of immunoglobulin (Ig)A nephropathy (IgAN), 30 of membranous GN (MGN), 6 of mesangiocapillary GN (MCGN); and 12 of focal segmental GN (FSGS). The risk factors for kidney allograft loss, defined as dialysis reintroduction after GN onset, were identified through are historical cohort study.

Clinical Findings

After the onset of posttransplantation GN, the median time to dialysis introduction was 46 months. The risk factors for kidney allograft loss were as follows: male gender (hazard ratio [HR] = 1.92; 95% confidence intervall [CI] 1.0–3.70; P = .052), initial unsatisfactory kidney function (HR = 1.86 per 1 mg/dL serum creatinine increment; 95% CI 1.0–3.46; P < .05), graft dysfunction at diagnosis (HR = 1.65 per 1 mg/dL serum creatinine increment; 95% CI 1.32–2.07; P < .001), nephrotic syndrome (HR = 2.3; 95% CI 1.13–4.99; P < .05) late-onset GN (HR = 1.1 per each additional year of observation, 95% CI 1.0–1.21; P < .05), and MPGN as a type of GN. Enhanced immunosuppression increased and ACEI and/or statin treatment decreased the risk of return to dialysis, respectively: HR = 1.56, 95% CI 0.76–3.18, P = .22; HR = 0.39, 95% CI 0.16–0.98, P = .0037; and HR = 0.367, 95% CI 0.15–0.88, P = .025.

Conclusions

Identification of risk factors can help discover patients who will have a faster progression to kidney allograft loss due to GN. In posttransplantation GN, statins and/or ACEI should be prescribed, if there are no contraindications.