IgA Nephropathy Recurrence after Kidney Transplantation: Role of Recipient Age and Human Leukocyte Antigen-B Mismatch

Abstract

Background: Recurrence of immunoglobulin (Ig)A nephropathy (rIgAN) is a growing cause of kidney allograft dysfunction. This study was aimed at investigating factors associated with rIgAN and the subsequent progression to end-stage renal disease (ESRD). Methods: Retrospective study including consecutive patients with IgA nephropathy (IgAN) who received a kidney transplant in our center between 1992 and 2016 and had a renal biopsy by clinical indication. The date of detection of chronic kidney disease (CKD) 5 was used as renal outcome. Results: Eighty-six kidney transplants were Developing a Risk Score of IgAN Recurrence 359 Am

Clinical Predictors and Prognosis of Recurrent IgA Nephropathy in the Kidney Allograft

“…Previous studies have suggested that HLA mismatch may reduce the risk of recurrent IgAN [10,20,21]. Our findings do not support an approach that encourages HLA mismatching in patients with IgAN undergoing renal transplantation for 2 reasons.…”

“…6 Histologic Oxford scores could not be assessed in 1 patient. [10][11][12][13][14][15]. Notably, younger recipient age is not universally associated with recurrent glomerulonephritis.…”

“…Our understanding of the determinants of recurrence and prognosis of IgAN in the kidney allograft is limited [6,7]. Some [8][9][10], but not all [11], reports have shown that recurrent IgAN is associated with a guarded outcome. A few studies have suggested that younger recipient age [8,[10][11][12][13][14][15], steroid-free regimen [16][17][18], allograft from living-related donor [8,14,19], and donor-recipient HLA matching [10,20,21] may predict recurrent disease.…”

Antibody-Mediated Rejection and Recurrent Primary Disease: Two Main Obstacles in Abdominal Kidney, Liver, and Pancreas Transplants

“…Thus, the control of IgAN recurrence remains an unmet need in the field of renal transplantation. Several factors may affect the pathogenesis of IgAN recurrence, such as low levels of immunosuppression, especially steroid avoidance [56] or HLA mismatch [57].…”

“…Since HLA mismatch was suggested as a risk factor for the recurrence, there may exist a difference in outcomes between related or unrelated donor transplants [64]. Rodas et al reported that full mismatches in HLA-B mitigated the recurrence of IgAN by examining 86 transplants, which included 38 living donor transplants [57].…”