Recurrent Glomerulonephritis Under Rapid Discontinuation of Steroids

Abstract

Background Recurrent glomerulonephritis (GN) remains an important cause of kidney allograft loss and whether rapid discontinuation of steroids (RDS) is associated with a higher risk of recurrence is not known. Methods We studied recurrence rate, and graft and patient survival in four groups of recipients: 216 recipients with GN transplanted under RDS (group 1), 978 concurrent non-GN recipients transplanted under RDS (group 2), 260 historic comparator group transplanted for GN between 1994 and 1999 with steroid maintenance (group 3), and 950 recipients who were also transplanted between 1994 and 1999 for non-GN and also maintained on steroids (group 4). Regression analysis adjusting for donor and recipient factors, steroid and sirolimus use, and also GN type was used to address factors associated with recurrent disease. Results The 1-, 5-, and 7-year recurrence rate in the GN group under RDS was 6.7%, 13.7%, and 19.2% and in historic GN recipients maintained on steroids it was 2.4%, 3.8%, and 5.3%, respectively (P<0.0001). RDS was associated with a higher adjusted risk of recurrent disease for all GN types (hazard ratio 4.86; 95% confidence interval 2.34 –10.07; P<0.0001). Graft and patient survival were similar in the two GN groups and both were highest among all groups. Notably, death-censored graft survival was not different among the groups. Conclusion Steroid avoidance may be associated with a higher rate of recurrent GN but no apparent increase in risk of graft loss. This group of recipients needs to be studied more carefully, in larger numbers, and for a longer time period.

The risk of recurrent IgA nephropathy in a steroid‐free protocol and other modifying immunosuppression

“…Our finding of increased incidence of IgAN recurrence and shorter graft survival associated with sirolimus is interesting and contrary to that reported by Kukla et al., who observed a lower risk of recurrent glomerulonephritis with sirolimus . In contrast to the Kukla et al.…”

“…A recent study by Kukla et al. has also shown a higher risk of recurrence of primary glomerulonephritis with steroid avoidance . In our study, patients withdrawn from steroids more than six months after transplantation appeared to have a similar low risk of IgAN recurrence as those maintained on steroids (by Kaplan–Meier analysis), possibly suggesting safety of steroid removal at this time point post‐transplant.…”

Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

“…Recurrence of some glomerulopathies following steroid avoidance has been noted to be higher than with steroid continuation. Patient and graft survival was not affected in patients inducted on rATG and maintained on TAC and MMF [44,52]. In a study comprising 124 kidney transplant recipients, of whom 91% were on rATG induction Visger et al, also had the same results as shown by Kuklan [44,53].…”

Corticosteroid minimization in renal transplantation: Careful patient selection enables feasibility

“…It has been hypothesized that CS minimization may increase post-transplant glomerulonephritis recurrence. In a major retrospective study, it was found that recurrence rate was indeed higher with rapid CS discontinuation compared to CS maintenance for all glomerulonephritis types (hazard ratio 4.86, 95%CI: 2.34-10.07, P < 0.0001)[27]. The analysis also showed no difference in patient, allograft, and death-censored allograft survival.…”