Efficacy of tonsillectomy for the treatment of immunoglobulin A nephropathy recurrence after kidney transplantation

Abstract

Background: Post-transplant recurrent nephritis is the third common complication that leads to graft loss, which affects the long-term graft survival of kidney transplant patients. Immunoglobulin A nephropathy (IgAN) is the most common for recurrent nephritis, with a recurrence rate of 13-53%. In this study, 12 patients diagnosed with recurrent IgAN were divided into two groups, one which underwent tonsillectomy and another which did not, to analyze the effect of treating IgAN recurrent with or without tonsillectomy. Methods: Urinary findings, estimated GFR (eGFR), and histopathological alteration (Banff and Oxford classifications) were examined for >5 years after kidney transplantation. Results: We found that tonsillectomy protected graft function and prevented pathological alterations. The levels of urinary proteins increased in the no tonsillectomy group, whereas no difference was observed in the severity of hematuria between two groups. eGFR declined and mesangial hypercellularity score increased in the no tonsillectomy group. Conclusions: Tonsillectomy not only results in a favorable clinical outcome but also protects against the histological damage caused by recurrent IgAN after kidney transplantation.

Protocol graft biopsy in kidney transplantation

“…Tonsillectomy could attenuate urinary findings and maintain stability of glomerular lesions in transplant patients . If tonsillectomy is not performed, variables such as mesangial hypercellularity score and glomerular sclerosis index will worsen with disease progression . IgA nephropathy runs a silent course, taking about 10–20 years to reach end‐stage renal disease (ESRD), long‐term observation is thus necessary to determine the benefits of tonsillectomy based on protocol biopsy findings.…”

Dysbiosis in the Salivary Microbiome Associated with IgA Nephropathy—‍A‍ ‍Japanese Cohort Study

“…In Japan, tonsillectomy monotherapy or tonsillectomy paired with steroid pulse therapy is one of the most effective therapeutic regimens for early-stage primary IgAN patients ( Xie et al , 2003 ; Nihei et al , 2017 ). The efficacy of this treatment is attributed to the relationship between focal tonsillar infection and increases in pIgA-secreting plasma cells in the tonsils of IgAN patients ( Meng et al , 2012 ).…”