Glomerular disease recurrence in second and subsequent kidney transplants

Abstract

Clinically significant disease recurrence does not necessarily affect re-transplants following loss of the first graft to disease recurrence. Selected patients who experience first graft failure due to recurrent glomerular disease should not be precluded from receiving a second transplant.

Renal transplant outcomes in primary FSGS compared with other recipients and risk factors for recurrence: A national review of the Irish Transplant Registry

“…Our data and previous research demonstrates that these patients often have recurrence in second or subsequent renal allografts . In a previous report by our center, four of 10 patients had not developed recurrence at last follow‐up. Two of these patients subsequently developed recurrence and are therefore included in the r‐FSGS group in this study.…”

“…Our group previously reviewed retransplantation in ten patients following first graft loss due to biopsy‐proven r‐FSGS . Six patients developed recurrence (in their second transplant) within 1 year.…”

“…8 Our group previously reviewed retransplantation in ten patients following first graft loss due to biopsy-proven r-FSGS. 9 Six patients developed recurrence (in their second transplant) within 1 year. Four of the 10 patients had no clinical evidence of recurrence at 3, 6, 7, and 21 years post-second transplant, suggesting recurrence in a second transplant is very common (but not inevitable) in this setting.…”

How to Deal With Kidney Retransplantation—Second, Third, Fourth, and Beyond

“…64 Although the incidence of recurrent glomerular disease may be higher in repeat KT, 64 it may not always recur or shorten survival in subsequent transplants. 65 FSGS, aHUS, Henoch Schonlein purpura, and primary hyperoxaluria are some of the diseases resulting in recurrence with the latter 3 predominantly seen in the pediatric population. 66,67 Availability and increased repertoire of genetic testing in recent years has improved our ability to stratify the risk of graft loss and manage some diseases prone to recurrence.…”

Recurrent glomerular disease in the kidney allograft

“…The risk of recurrence in a second allograft in patients with prior graft loss due to IgAN is significant with high reported rates of graft loss (25%-60%) (39,55,60). However, a recently-published retrospective review of 33 patients with second transplant due to primary disease recurrence, 75% of the patients with IgAN had no significant graft dysfunction more than ten years following their second transplant (61). This may suggest that patients with graft loss due to recurrent IgAN should be still considered for re-transplantation.…”