Recurrent glomerulonephritis following renal transplantation and impact on graft survival

Abstract

BackgroundRecurrence of primary glomerulonephritis in the post-transplant period has been described in the literature but the risk remains poorly quantified and its impact on allograft outcomes and implications for subsequent transplants remain under-examined. Here we describe the rates and timing of post-transplant glomerulonephritis recurrence for IgA nephropathy, focal segmental glomerulosclerosis, mesangiocapillary GN and membranous GN based on 28 years of ANZDATA registry transplant data.MethodsWe investigated the rates of GN 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.ResultsGN recurrence occurred in 10.5% of transplants and was most common in mesangiocapillary GN. Median time to recurrence was shorter for FSGS compared to IGAN. GN recurrence was less common in patients over 50 years of age and after unrelated kidney donation. We identified a significantly higher risk of recurrence in secondary grafts following recurrence in a primary allograft for FSGS (RR 5.70, 95 CI: 2.41–13.5, p < 0.001) but not IGAN, MCGN or MN. At 10 years, recurrence occurs in 8.7, 10.8, 13.1, and 13.4% of allografts for FSGS, IGAN, MCGN and MN respectively. In all GN, recurrence significantly reduced death censored graft survival at 5 and 10 years.ConclusionsGN recurrence occurs in a minority of patients at a significantly different rate for each GN. After a recurrence, there is no evidence for an increased risk of further recurrence in a subsequent graft except in FSGS.

Recurrent Glomerulonephritis after Renal Transplantation: The Clinical Problem

“…Jiang et al conducted a study showing that recurrent GN also depends on male gender, early age, duration on dialysis less than 5 years before transplant; this study confirm that there is no evidence for an increased risk of recurrence in a subsequent graft except for FSGS [ 17 , 18 ]; on the contrary, Ohmacht et al highlight higher risks in IgAN for second graft [ 19 ].…”

“…Previous studies report that there is a grown risk of recurrence of IgAN in a subsequent graft [ 55 ]. Conversely, recent studies suggested that there is no increased risk of recurrence on patients who lost the first graft for recurrence [ 18 ].…”

Immunoglobulin A Nephropathy. Recurrence After Renal Transplantation

“…The rate of recurrence can be underestimated if all patients who receive a renal transplant do not have a histological diagnosis of the original disease, or if the follow-up after transplant is too short. Recurrence rate reported in the ANZDATA registry for IgAN at 5 and at 10 years were, respectively 5.4% (4.3–6.5) and 10.8% (9.2–12.5%) (4). These data suggest that, recurrence of IgAN is apparently a time dependent event; the longer the follow-up, the higher the probability of recurrence.…”

“…The variable indication to graft biopsy in the different centers is one of the reasons. The rate of IgAN recurrence is higher in studies in which protocol biopsies are performed (5) in comparison to studies that reported graft biopsies done for clinical reasons only (6, 7) and in Registry analysis (4). As a matter of fact, recurrences of IgAN can be “histological only” when diagnosed on protocol biopsies in asymptomatic patients; or “clinical,” when associated with urinary abnormalities and/or graft dysfunction.…”

“…Owing to the progressive improvement of graft survival resulting from reduced incidence of acute rejection, the number of patients potentially exposed to recurrence has increased. The incidence of IgAN recurrence is not clearly estimated; it is reported to range from 9 to 53% (4, 5), but the incidence increases if we consider only patients submitted to graft biopsy. Several reasons can account for this large discrepancy.…”