Recurrence of Secondary Glomerular Disease after Renal Transplantation

Abstract

SummaryThe risk of a posttransplant recurrence of secondary glomerulonephritis (GN) is quite variable. Histologic recurrence is frequent in lupus nephritis, but the lesions are rarely severe and usually do not impair the longterm graft outcome. Patients with Henoch-Schonlein nephritis have graft survival similar to that of other renal diseases, although recurrent Henoch-Schonlein nephritis with extensive crescents has a poor prognosis. Amyloid light-chain amyloidosis recurs frequently in renal allografts but it rarely causes graft failure. Amyloidosis secondary to chronic inflammation may also recur, but this is extremely rare in patients with Behcet's disease or in those with familial Mediterranean fever, when the latter are treated with colchicine. Double organ transplantation (liver/kidney; heart/kidney), chemotherapy, and autologous stem cell transplantation may be considered in particular cases of amyloidosis, such as hereditary amyloidosis or multiple myeloma. There is little experience with renal transplantation in light-chain deposition disease, fibrillary/ immunotactoid GN, or mixed cryoglobulinemic nephritis but successful cases have been reported. Diabetic nephropathy often recurs but usually only after many years. Recurrence in patients with small vessel vasculitis is unpredictable but can cause graft failure. However, in spite of recurrence, patient and graft survival rates are similar in patients with small vessel vasculitis compared with those with other renal diseases. Many secondary forms of GN no longer represent a potential contraindication to renal transplantation. The main issues in transplantation of patients with secondary GN are the infectious, cardiovascular, or hepatic complications associated with the original disease or its treatment.

Untitled

“…Up to 26% of patients with reactionary amyloidosis secondary to chronic inflammatory disorders such as rheumatoid arthritis and familial Mediterranean fever may develop a renal recurrence. 41 In our study, we found a biopsy-proven recurrence rate of 8.3% of all diagnosed cases of renal amyloidosis pretransplant.…”

Liver Failure Caused by Light Chain Deposition Disease Associated with Multiple Myeloma

“…Most such cases end up rapidly developing end-stage renal disease (ESRD). Hemodialysis and kidney transplantation are the available treatment options at this stage but light chain deposition with renal impairment has been also described in the transplanted organ (21). Interestingly the present patient's serum or urine analysis parameters for kidney function were strictly normal.…”

Histopathological findings in transplanted kidneys

“…IgAN recurrence occurs typically more than 3 years after transplantation. The risk of graft loss due to IgAN recurrence ranged from 3 to 5% [132]. Compared with IgAN, relatively little is known about recurrent IgA vasculitis in renal allografts.…”

“…Recurrence occurs early, usually in the first year post-transplantation. The risk for graft loss is~15% at 10 years [132]. Information on recurrence rates for MPGN type III is limited.…”