Kidney transplantation in patients with IgA mesangial glomerulonephritis11See Editorial by Hogg, p. 2033.

Ponticelli, Claudio; Traversi, Lara; Feliciani, Annalisa; Cesana, Bruno Mario; Banfi, Giovanni; Tarantino, A

doi:10.1046/j.1523-1755.2001.00006.x

Cited by 166 publications

(55 citation statements)

References 15 publications

(1 reference statement)

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“…Though the rate of recurrence of IgAN is high (9 – 61% in the literature; 22.5% in this study), the rate of graft loss due to IgAN is thought to be low (3–4%) 8,21 . Moroni et al 11 analyzed the post-transplant outcomes of 190 patients with IgAN transplanted between 1981 and 2010.…”

Section: Discussioncontrasting

confidence: 47%

Predicting Post-Transplant Recurrence of IgA Nephropathy: The Importance of Crescents

Avasare¹,

Rosenstiel

Zaky

et al. 2017

Am J Nephrol

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Background: Most studies that have assessed the predictors of recurrent IgA nephropathy (IgAN) in the renal allograft have focused on post-transplant features. Identifying high-risk pre-transplant features of IgAN is useful for counseling patients and may help in tailoring post-transplant immunosuppression. Methods: We investigated the pre-transplant clinical and biopsy features of 62 patients with IgAN who received transplants at Columbia University Medical Center from 2001 to 2012 and compared the characteristics and outcomes of patients with IgAN recurrence to those without recurrence. The primary outcome was time to recurrent IgAN. Secondary outcomes were a composite of doubling of creatinine or allograft failure, and recurrent IgAN as a cause of allograft dysfunction. Results: Of the 62 patients, 14 had recurrent IgAN in the allograft. Mean time to recurrence was 2.75 years. Those with recurrent disease were younger at the time of native kidney biopsy (29 vs. 41 years, p < 0.0009). Black race and Hispanic ethnicity composed a higher proportion of the recurrent disease group. On multivariable analysis, significant predictors of recurrent IgAN included age at diagnosis (hazards ratio (HR) 0.911, 95% CI 0.85-0.98), burden of crescents on native biopsy (HR 1.21 per 10% increase in crescents, 95% CI 1.00-1.47) and allograft rejection (HR 3.59, 95% CI 1.10-11.7). Conclusions: Features of native IgAN can help predict the risk of recurrent disease in the renal allograft. In particular, immunologically active disease represented by earlier age of onset and greater burden of crescents on native biopsy is more likely to recur after transplant.

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Section: Discussioncontrasting

confidence: 47%

Predicting Post-Transplant Recurrence of IgA Nephropathy: The Importance of Crescents

Avasare¹,

Rosenstiel

Zaky

et al. 2017

Am J Nephrol

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“…The ERA-EDTA registry analysis [26] reported increased MCGN recurrence, but equivalent graft survival in living donor grafts, whether related or not. Other studies have likewise failed to find an association between live related donation and GN recurrence [30–33]. …”

Section: Discussionmentioning

confidence: 99%

Increased glomerulonephritis recurrence after living related donation

2017

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BackgroundKidney transplantation confers superior outcomes for patients with end stage kidney disease, and live donor kidneys associate with superior outcomes compared to deceased donor kidneys. Modern immunosuppression has improved rejection rates and transplant survival and, as a result, recurrence of glomerulonephritis has emerged as a major cause of allograft loss. However, many glomerulonephritides have significant genetic risk which may manifest through kidney intrinsic or systemic mechanisms. We hypothesise that heritable kidney intrinsic predisposition to glomerulonephritis will result in increased risk of glomerulonephritis recurrence in kidneys transplanted from genetically related donors.MethodsWe investigated the effect of living related donation on rates of recurrence and subsequent graft outcomes in 7236 patient from 28 years of ANZDATA transplant registry data. Data were analysed in R, using Kaplan Meier Survival analysis and adjusted analyses performed using Cox Proportional Hazards methods. A competing risk model was also analysed.ResultsGlomerulonephritis recurrence rates were significantly higher in living related donor grafts compared to either living unrelated or deceased donor grafts (p < 0 · 001). In IgA nephropathy, transplantation from living related donor kidneys demonstrated a 10 year recurrence rate of 16 · 7% compared to 7 · 1% in living unrelated donors and 9 · 2% in deceased donors (HR:1 · 7, 95% CI:1 · 26–2 · 26, p = 0 · 0005 for living related vs deceased donors). In focal segmental glomerulosclerosis, risk of recurrence at 10 years was 14 · 6% in living related donors compared to 10 · 8% in living unrelated donors and 6 · 6% in deceased donors (HR:2 · 2, 95% CI 1 · 34–3 · 64, p = 0 · 002) for living related vs deceased donors. Primary glomerulonephritis death censored graft survival was superior for living donor grafts, related or unrelated, compared to deceased donor grafts.ConclusionsWe identified a significant increase in the risk of glomerulonephritis recurrence in IgA Nephropathy and Focal Segmental Glomerulosclerosis in living related donors compared to a deceased donors.

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“…Of these, graft failure develops in 18.7–26.5 % and graft loss occurs in 1.3–10 % 10 years later [3, 5, 6]. re-IgAN influences long-term graft outcome [4, 7]. …”

Section: Discussionmentioning

confidence: 99%

Five cases of tonsillectomy and steroid pulse therapy for recurrent immunoglobulin A nephropathy after kidney transplantation

Hoshino

Endo

et al. 2013

CEN Case Rep

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Five cases of recurrent immunoglobulin A nephropathy (IgAN) after kidney transplantation were successfully treated by tonsillectomy and steroid pulse therapy (SPT). The clinical background and pathology in the five cases were different, but good results were obtained in all of them. In cases 1 and 2, mild recurrent IgAN developed and failed to remit after tonsillectomy alone, but a remission was achieved in both cases after SPT. In case 3, highly active recurrent IgAN with crescent lesions developed 13 years after kidney transplantation, and a remission was achieved after SPT. In case 4, renal biopsy specimens showed pathological findings of recurrent IgAN with tubulitis, and hematuria and proteinuria resolved after SPT. In case 5, the biopsy findings indicated recurrent IgAN with chronic rejection. Tonsillectomy was followed by resolution of the proteinuria, and a remission was achieved after SPT. In conclusion, SPT is effective in inducing a remission of recurrent IgAN when tonsillectomy alone fails.

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Kidney transplantation in patients with IgA mesangial glomerulonephritis11See Editorial by Hogg, p. 2033.

Abstract: The ten-year graft survival rate was similar in patients with IgAGN or other renal diseases. At least 35% IgAGN patients had biopsy-proven recurrence, and younger patients were more prone to the risk of recurrence. Recurrence did not affect the ten-year graft survival.

Cited by 166 publications

References 15 publications

Predicting Post-Transplant Recurrence of IgA Nephropathy: The Importance of Crescents

Predicting Post-Transplant Recurrence of IgA Nephropathy: The Importance of Crescents

Increased glomerulonephritis recurrence after living related donation

Five cases of tonsillectomy and steroid pulse therapy for recurrent immunoglobulin A nephropathy after kidney transplantation

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