Recurrence of IgA Nephropathy after Kidney Transplantation in Adults.
Adult
Allografts
/ immunology
Antibodies
/ blood
Biopsy
Brazil
/ epidemiology
Europe
/ epidemiology
Female
Glomerulonephritis, IGA
/ complications
Graft Survival
Humans
Incidence
Kidney
/ pathology
Kidney Failure, Chronic
/ etiology
Kidney Transplantation
Male
Middle Aged
Recurrence
Retrospective Studies
Risk Factors
United States
/ epidemiology
IgA deposition
IgA nephropathy
glomerular disease
graft survival
kidney transplantation
recurrence
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
19
01
2021
accepted:
21
06
2021
entrez:
7
8
2021
pubmed:
8
8
2021
medline:
15
1
2022
Statut:
ppublish
Résumé
In patients with kidney failure due to IgA nephropathy, IgA deposits can recur in a subsequent kidney transplant. The incidence, effect, and risk factors of IgA nephropathy recurrence is unclear, because most studies have been single center and sample sizes are relatively small. We performed a multicenter, international, retrospective study to determine the incidence, risk factors, and treatment response of recurrent IgA nephropathy after kidney transplantation. Data were collected from all consecutive patients with biopsy-proven IgA nephropathy transplanted between 2005 and 2015, across 16 "The Post-Transplant Glomerular Disease" study centers in Europe, North America, and South America. Out of 504 transplant recipients with IgA nephropathy, recurrent IgA deposits were identified by kidney biopsy in 82 patients; cumulative incidence of recurrence was 23% at 15 years (95% confidence interval, 14 to 34). Multivariable Cox regression revealed a higher risk for recurrence of IgA deposits in patients with a pre-emptive kidney transplant (hazard ratio, 3.45; 95% confidence interval, 1.31 to 9.17) and in patients with preformed donor-specific antibodies (hazard ratio, 2.59; 95% confidence interval, 1.09 to 6.19). After kidney transplantation, development of In our international cohort, cumulative risk of IgA nephropathy recurrence increased after transplant and was associated with a 3.7-fold greater risk of graft loss.
Sections du résumé
BACKGROUND AND OBJECTIVES
In patients with kidney failure due to IgA nephropathy, IgA deposits can recur in a subsequent kidney transplant. The incidence, effect, and risk factors of IgA nephropathy recurrence is unclear, because most studies have been single center and sample sizes are relatively small.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
We performed a multicenter, international, retrospective study to determine the incidence, risk factors, and treatment response of recurrent IgA nephropathy after kidney transplantation. Data were collected from all consecutive patients with biopsy-proven IgA nephropathy transplanted between 2005 and 2015, across 16 "The Post-Transplant Glomerular Disease" study centers in Europe, North America, and South America.
RESULTS
Out of 504 transplant recipients with IgA nephropathy, recurrent IgA deposits were identified by kidney biopsy in 82 patients; cumulative incidence of recurrence was 23% at 15 years (95% confidence interval, 14 to 34). Multivariable Cox regression revealed a higher risk for recurrence of IgA deposits in patients with a pre-emptive kidney transplant (hazard ratio, 3.45; 95% confidence interval, 1.31 to 9.17) and in patients with preformed donor-specific antibodies (hazard ratio, 2.59; 95% confidence interval, 1.09 to 6.19). After kidney transplantation, development of
CONCLUSIONS
In our international cohort, cumulative risk of IgA nephropathy recurrence increased after transplant and was associated with a 3.7-fold greater risk of graft loss.
Identifiants
pubmed: 34362788
pii: 01277230-202108000-00016
doi: 10.2215/CJN.00910121
pmc: PMC8455056
doi:
Substances chimiques
Antibodies
0
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1247-1255Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001102
Pays : United States
Informations de copyright
Copyright © 2021 by the American Society of Nephrology.
Références
Marinaki S, Lionaki S, Boletis JN: Glomerular disease recurrence in the renal allograft: A hurdle but not a barrier for successful kidney transplantation. Transplant Proc 45: 3–9, 2013
Wyld ML, Chadban SJ: Recurrent IgA nephropathy after kidney transplantation. Transplantation 100: 1827–1832, 2016
Floege J: Recurrent IgA nephropathy after renal transplantation. Semin Nephrol 24: 287–291, 2004
Ponticelli C, Traversi L, Feliciani A, Cesana BM, Banfi G, Tarantino A: Kidney transplantation in patients with IgA mesangial glomerulonephritis. Kidney Int 60: 1948–1954, 2001
Berthoux F, El Deeb S, Mariat C, Diconne E, Laurent B, Thibaudin L: Antithymocyte globulin (ATG) induction therapy and disease recurrence in renal transplant recipients with primary IgA nephropathy. Transplantation 85: 1505–1507, 2008
Han SS, Huh W, Park SK, Ahn C, Han JS, Kim S, Kim YS: Impact of recurrent disease and chronic allograft nephropathy on the long-term allograft outcome in patients with IgA nephropathy. Transpl Int 23: 169–175, 2010
Ortiz F, Gelpi R, Koskinen P, Manonelles A, Räisänen-Sokolowski A, Carrera M, Honkanen E, Grinyó JM, Cruzado JM: IgA nephropathy recurs early in the graft when assessed by protocol biopsy. Nephrol Dial Transplant 27: 2553–2558, 2012
Moroni G, Longhi S, Quaglini S, Gallelli B, Banfi G, Montagnino G, Messa P: The long-term outcome of renal transplantation of IgA nephropathy and the impact of recurrence on graft survival. Nephrol Dial Transplant 28: 1305–1314, 2013
Sato Y, Ishida H, Shimizu T, Tanabe K: Evaluation of tonsillectomy before kidney transplantation in patients with IgA nephropathy. Transpl Immunol 30: 12–17, 2014
Von Visger JR, Gunay Y, Andreoni KA, Bhatt UY, Nori US, Pesavento TE, Elkhammas EA, Winters HA, Nadasdy T, Singh N: The risk of recurrent IgA nephropathy in a steroid-free protocol and other modifying immunosuppression. Clin Transplant 28: 845–854, 2014
Nijim S, Vujjini V, Alasfar S, Luo X, Orandi B, Delp C, Desai NM, Montgomery RA, Lonze BE, Alachkar N: Recurrent IgA nephropathy after kidney transplantation. Transplant Proc 48: 2689–2694, 2016
Avasare RS, Rosenstiel PE, Zaky ZS, Tsapepas DS, Appel GB, Markowitz GS, Bomback AS, Canetta PA: Predicting post-transplant recurrence of IgA nephropathy: The importance of crescents. Am J Nephrol 45: 99–106, 2017
Di Vico MC, Messina M, Fop F, Barreca A, Segoloni GP, Biancone L: Recurrent IgA nephropathy after renal transplantation and steroid withdrawal. Clin Transplant 32: e13207, 2018
Uffing A, Pérez-Sáez MJ, La Manna G, Comai G, Fischman C, Farouk S, Manfro RC, Bauer AC, Lichtenfels B, Mansur JB, Tedesco-Silva H, Kirsztajn GM, Manonelles A, Bestard O, Riella MC, Hokazono SR, Arias-Cabrales C, David-Neto E, Ventura CG, Akalin E, Mohammed O, Khankin EV, Safa K, Malvezzi P, O’Shaughnessy MM, Cheng XS, Cravedi P, Riella LV: A large, international study on post-transplant glomerular diseases: The TANGO project. BMC Nephrol 19: 229, 2018
Suzuki H, Kiryluk K, Novak J, Moldoveanu Z, Herr AB, Renfrow MB, Wyatt RJ, Scolari F, Mestecky J, Gharavi AG, Julian BA: The pathophysiology of IgA nephropathy. J Am Soc Nephrol 22: 1795–1803, 2011
Kanaan N, Mourad G, Thervet E, Peeters P, Hourmant M, Vanrenterghem Y, De Meyer M, Mourad M, Maréchal C, Goffin E, Pirson Y: Recurrence and graft loss after kidney transplantation for Henoch-Schonlein purpura nephritis: A multicenter analysis. Clin J Am Soc Nephrol 6: 1768–1772, 2011
Wang AY, Lai FM, Yu AW, Lam PK, Chow KM, Choi PC, Lui SF, Li PK: Recurrent IgA nephropathy in renal transplant allografts. Am J Kidney Dis 38: 588–596, 2001
Freese P, Svalander C, Nordén G, Nyberg G: Clinical risk factors for recurrence of IgA nephropathy. Clin Transplant 13: 313–317, 1999
Lionaki S, Skalioti C, Boletis JN: Kidney transplantation in patients with systemic lupus erythematosus. World J Transplant 4: 176–182, 2014
Clayton P, McDonald S, Chadban S: Steroids and recurrent IgA nephropathy after kidney transplantation. Am J Transplant 11: 1645–1649, 2011
Leeaphorn N, Garg N, Khankin EV, Cardarelli F, Pavlakis M: Recurrence of IgA nephropathy after kidney transplantation in steroid continuation versus early steroid-withdrawal regimens: A retrospective analysis of the UNOS/OPTN database. Transpl Int 31: 175–186, 2018
Mulay AV, van Walraven C, Knoll GA: Impact of immunosuppressive medication on the risk of renal allograft failure due to recurrent glomerulonephritis. Am J Transplant 9: 804–811, 2009
Barbour S, Djurdjev O, Gill JS, Dong JJ, Gill J: A propensity score matched analysis shows no adverse effect of early steroid withdrawal in non-diabetic kidney transplant recipients with and without glomerulonephritis. Kidney Int 96: 460–469, 2019
Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group: KDIGO clinical practice guideline for the care of kidney transplant recipients. Available at: https://kdigo.org/guidelines . Accessed December 14, 2020