Clinical risk factors for recurrence of IgA nephropathy

Abstract

No clinical risk factors for recurrence of immunoglobulin A (IgA) nephropathy in kidney transplants have been defined. This is a single-centre retrospect analysis of recurrence in 104 first kidney transplant patients with biopsy-verified IgA nephropathy. Fifty patients had living donors. All but an identical twin were treated with cyclosporin A. The median follow-up time was 5 yr. Graft biopsies had been obtained from 35 grafts later than 6 months after transplantation, due to deteriorating graft function or gross proteinuria. Thirteen biopsies showed mesangial glomerulopathy proliferative in eleven cases with IgA deposits. Recurrence caused failure of six grafts. Eleven grafts with recurrence were from living donors (p = 0.005). No specific human leukocyte antigen (HLA) was identified as a risk factor. Known duration of original disease until end-stage renal failure was significantly shorter in patients with recurrence (median 5 yr, range 0-25 yr) compared with those without (median of 10 yr, range of 0-37 yr) (p = 0.015). Cumulative graft survival was not reduced in living versus cadaveric donor recipients.

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…The incidence of histologic recurrence has been shown to increase with duration of follow-up after transplantation (308). Clinical recurrence (variously defined) has been reported in most studies to be 20-40% (273,275,278,283,300,(308)(309)(310)(311)(312)(313)(314)(315). However, in the largest series (nΩ104, median follow-up of 5 years) clinical recurrence occurred in only 12.5% (315).…”

“…Clinical recurrence (variously defined) has been reported in most studies to be 20-40% (273,275,278,283,300,(308)(309)(310)(311)(312)(313)(314)(315). However, in the largest series (nΩ104, median follow-up of 5 years) clinical recurrence occurred in only 12.5% (315). Of those with recurrent disease, graft failure occurs in 6-33% (283,300,308,309,(311)(312)(313)(314)(315).…”

“…Of those with recurrent disease, graft failure occurs in 6-33% (283,300,308,309,(311)(312)(313)(314)(315). A shorter interval between onset and ESRD appears to correlate with recurrent disease (314,315). Recurrence is more common in recipients of living-related transplants (309,315), but donor source does not appear to affect graft survival in patients with IgA nephropathy (314,315).…”

“…However, in the largest series (nΩ104, median follow-up of 5 years) clinical recurrence occurred in only 12.5% (315). Of those with recurrent disease, graft failure occurs in 6-33% (283,300,308,309,(311)(312)(313)(314)(315). A shorter interval between onset and ESRD appears to correlate with recurrent disease (314,315).…”

“…A shorter interval between onset and ESRD appears to correlate with recurrent disease (314,315). Recurrence is more common in recipients of living-related transplants (309,315), but donor source does not appear to affect graft survival in patients with IgA nephropathy (314,315). Therefore, a living donor transplant should not be discouraged.…”