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Glomerulonephritis (GN) is the leading cause of chronic kidney disease among recipients of renal transplants. Because modern immunosuppressive regimens have reduced the incidence of rejection-related graft loss, the probability and clinical significance of posttransplantation GN (PTGN) requires reevaluation. In this Canadian epidemiologic study, we monitored 2026 sequential renal transplant recipients whose original renal disease resulted from biopsy-proven GN (36%), from presumed GN (7.8%), or from disorders other than GN (56%) for 15 yr without loss to follow-up. Kaplan-Meier estimates of PTGN in the whole population were 5.5% at 5 yr, 10.1% at 10 yr, and 15.7% at 15 yr. PTGN was diagnosed in 24.3% of patients whose original renal disease resulted from biopsy-proven GN, compared with 11.8% of those with presumed GN and 10.5% of those with disorders other than GN. Biopsy-proven GN in the native kidney, male gender, younger age, and nonwhite ethnicity predicted PTGN. Current immunosuppressive regimens did not associate with a reduced frequency of PTGN. Patients who developed PTGN had significantly reduced graft survival (10.2 versus 69.7%; P < 0.0001). In summary, in the Canadian population, PTGN is a common and serious complication that causes accelerated graft failure, despite the use of modern immunosuppressive regimens.

Background. This longitudinal, sequential, matched closed-cohort design pharmacoepidemiological analysis examined the influence of maintenance steroid therapy in 380 first graft recipients after renal transplantation under conditions of normal clinical practice. Methods. Nonexposed (steroid avoidance, n= 190) and exposed (steroid treated, n= 190) cohorts were matched 1:1 for key demographic factors, including donor source (living or deceased), diabetic status, panel reactive antibody level, recipient age (by decade), and sex. Results. Cohorts were comparable for all variables except median human leukocyte antigen mismatch (4 vs. 3, P=0.03), use oftacrolimus (90.0% vs. 59.5%, P≤0.0001), and ofbasiliximab (94.7% vs. 57.4%, P≤0.0001), which were higher in the nonexposed cohort. Estimated glomerular filtration rate (mL/min/1.73 m 2 ) was comparable at 1 year (median: 58.1 vs. 58.3, P=0.92) and 2 years (median: 55.5 vs. 58.0, P=0.97) in nonexposed and in exposed cohorts (P=0.97). There was no difference in Kaplan-Meier estimates of biopsy-proven acute rejection (14.8% vs. 17.0%; hazard ratio: 0.88, P=0.60) or of 2-year death censored graft failure (4.7% vs. 3.2%; P=0.44) between nonexposed or exposed cohorts. Median total cholesterol (4.6 vs. 5.0 mmol/L, P=0.0002), low-density lipoprotein (2.6 vs. 2.8 mmol/L, P=0.005), high-density lipoprotein levels (1.1 vs. 1.3, P=0.0001), and median weight change from baseline (-1.7 vs. +1.0 kg, P=0.001) were significantly lower in the nonexposed cohort. Forty-five patients (29%) in the nonexposed cohort commenced steroid therapy, principally for graft dysfunction or acute rejection. Conclusion. In summary, steroid avoidance did not negatively impact 2-year graft function, biopsy-proven acute rejection rate, or short-term graft survival and offers clinical benefits, which weigh in the decision regarding maintenance therapy.