Recurrent Immunoglobulin A Nephropathy After Renal Transplantation

Abstract

Recurrent IgAN is a clinically relevant problem in renal transplant patients. Its importance may have been underestimated in the past due to inadequate lengths of follow-up.

Dysregulated LIGHT expression on T cells mediates intestinal inflammation and contributes to IgA nephropathy

“…Therefore, an alternative explanation for the effects of LTβR-Ig on IgAN may be reduced GVHD or colitis mediated by LTβR-IG treatment, and specific involvement of gut IgA production needs to be further elucidated. In 60% of IgAN patients that undergo renal transplantation, the disease recurs in the transplanted kidney (43). Our results suggest an important application for LTβR-Ig in the treatment of IgAN.…”

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“…Similarly, Ohmacht and coworkers previously reported that recurrence was frequent in patients who had rapid progression to ESRD and IgAN diagnosed by biopsy. 13 However, there was no difference in recurrence rates within the same age groups, according to period of progression to ESRD. The recurrent group of patients aged ≥ 20 years showed rapid deterioration from PS to RRT (23.4 vs 58.1 mo; P = .051) with poorer renal function than patients who had no recurrence, but statistical significance was not observed.…”

“…3 However, other investigators did not find a similar relation, and further studies about recurrence are required to corroborate or refute the finding. [11][12][13] In addition, there are no comparative data about recurrence according to age.…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…However, in the largest series (nΩ104, median follow-up of 5 years) clinical recurrence occurred in only 12.5% (315). Of those with recurrent disease, graft failure occurs in 6-33% (283,300,308,309,(311)(312)(313)(314)(315). A shorter interval between onset and ESRD appears to correlate with recurrent disease (314,315).…”

“…The incidence of histologic recurrence has been shown to increase with duration of follow-up after transplantation (308). Clinical recurrence (variously defined) has been reported in most studies to be 20-40% (273,275,278,283,300,(308)(309)(310)(311)(312)(313)(314)(315). However, in the largest series (nΩ104, median follow-up of 5 years) clinical recurrence occurred in only 12.5% (315).…”