Recurrent IgA nephropathy after renal transplantation and steroid withdrawal

Vico, Maria Cristina Di; Messina, Maria; Fop, Fabrizio; Barreca, Antonella; Segoloni, Giuseppe; Biancone, Luigi

doi:10.1111/ctr.13207

Cited by 29 publications

(23 citation statements)

References 30 publications

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“…Clayton et al (14) suggested that steroid withdrawal may increase graft loss risk because of recurrence of IgAN. These results were confirmed in two subsequent studies (72, 73). In a retrospective analysis of the UNOS/OPTN database that included 9,690 IgAN adults who received their first kidney transplant between 2000 and 2014, early steroid-withdrawal was associated with an increased risk of recurrence at multivariate analysis (72).…”

Section: Treatment Of Graft Recurrences Of Igan Patientssupporting

confidence: 74%

Immunoglobulin A Nephropathy. Recurrence After Renal Transplantation

et al. 2019

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IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. The disease generally runs an indolent course but may lead to ESRD in 20–30% of patients in 20 years or more after diagnosis. Patients with IgA nephropathy are ideal candidates for renal transplant because they are generally relatively young and with few comorbidities. Their graft survival is better or comparable to that of controls at 10 years, though few data are available after 10 years of follow-up. Recurrence of the original disease in the graft is a well-known complication of transplant in IgAN and is a significant cause of deterioration of graft function. Recurrent IgAN rarely manifests clinically before 3 years post transplantation. Recurrence rate is estimated to be around 30% with considerable differences among different series. Despite these factors there is no certain recurrence predictor, young age at renal transplant, rapid progression of the original disease and higher levels of circulating galactose-deficient IgA1 and IgA-IgG immune complexes are all associated with a higher rate of recurrence. Which pathogenetic mechanisms are responsible for the progression of the recurrence to graft function deterioration, and what therapy can prevent or slow down the progression of the disease in the graft, are open questions. The aim of this review is to describe the clinical outcome of renal transplantation in IgA patients with attention to the rate and the predictors of recurrence and to discuss the available therapeutic options for the management of recurrence.

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Section: Treatment Of Graft Recurrences Of Igan Patientssupporting

confidence: 74%

Immunoglobulin A Nephropathy. Recurrence After Renal Transplantation

et al. 2019

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“…Another study also revealed that the rate of recurrence of IgA nephropathy after kidney transplantation was higher among patients with steroid withdrawal at any time after transplant [36] . There is paucity of enough evidence for treatment and outcomes of recurrent GN after transplantation.…”

Section: Prevention or Treatment Of Recurrent Autoimmune Diseasesmentioning

confidence: 94%

Current Status of Glucocorticoid Usage in Solid Organ Transplantation

Dashti‐Khavidaki¹,

Saidi²,

Lü³

2021

Preprint

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Glucocorticoids (GCs) have been the mainstay of immunosuppressive therapy in solid organ transplantation (SOT) for decades due to their potent effects on the innate immunity and tissue protective effects. But, some SOT centers are reluctant to administer GCs for long-time due to the various side effects. This review summarizes advantages and disadvantages of GCs in SOT. PubMed and Scopus databases were searched from 2011 to April 2021 using search syntaxes cover “transplantation” and “glucocorticoids”.GCs are used in transplant recipients, transplant donors, and organ perfusate solution to improve transplant outcomes. In SOT recipients GCs are administered as induction and maintenance immunosuppressive therapy. GCs are also the cornerstone to treat acute anti-body- and T-cell-mediated rejections. Addition of GCs to organ perfusate solution and pretreatment of transplant donors with GCs are recommended by some guidelines and protocols to reduce ischemia-reperfusion injury peri-transplant. GCs with low bioavailability and high potency for GC receptors such as budesonide, nanoparticle-mediated targeted delivery of GCs to specific organs, and combination use of dexamethasone with inducers of immune-regulatory cells are new methods of GC usage in SOT patients to reduce side effects or induce immune-tolerance instead of immunosuppression. Various side effects on different non-targeted organs/tissues such as bone, cardiovascular, neuromuscular, skin, and gastrointestinal tract have been noted for GCs. There are also potential drug-drug interactions for GCs in SOT patients.

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“…Two single-center studies evaluating IgA nephropathy recurrence and steroid withdrawal have similar limitations, such as large differences in groups at baseline (including immunosuppression), no or limited multivariable analysis, IgA deposits that were not defined as recurrence when rejection was present in the biopsy, a higher risk of rejection in the steroid group, and possible selection bias of which patients received the steroid free regimen (71,72). Unfortunately, there are no prospective studies that look at early steroid withdrawal and recurrent IgA with protocol biopsies, although a retrospective study with protocol biopsies by Ortiz et al found an overall IgA nephropathy recurrence rate of 32%, with no association between IgA recurrence and steroid withdrawal (73).…”

Section: Iga Nephropathymentioning

confidence: 99%

Recurrent Glomerular Disease after Kidney Transplantation

Uffing

Hullekes

Riella

et al. 2021

CJASN

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Recurrent glomerular disease after kidney transplant remains an important cause of allograft failure. Many of the different entities post-transplant still suffer from incomplete knowledge on pathophysiology, and therefore lack targeted and effective therapies. In this review, we focus on specific clinical dilemmas encountered by physicians in managing recurrent glomerular disease by highlighting new insights into the understanding and treatment of post-transplant focal segmental glomerulosclerosis, membranous nephropathy, atypical hemolytic uremic syndrome, C3 glomerulopathy, amyloid light-chain (AL) amyloidosis, and IgA nephropathy.

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Recurrent IgA nephropathy after renal transplantation and steroid withdrawal

Cited by 29 publications

References 30 publications

Immunoglobulin A Nephropathy. Recurrence After Renal Transplantation

Immunoglobulin A Nephropathy. Recurrence After Renal Transplantation

Current Status of Glucocorticoid Usage in Solid Organ Transplantation

Recurrent Glomerular Disease after Kidney Transplantation

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