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1. Recurrence of iga nephropathy after kidney transplantation in adults

Author

Pitchaphon Nissaisorakarn, Xingxing S. Cheng, Claudia Bini, Audrey Uffing, Andrea Carla Bauer, Paolo Malvezzi, Fabiana Agena, Samira Farouk, Gaetano La Manna, Jesse D. Schold, Gianna Mastroianni-Kirsztajn, Marie-Camille Lafargue, Stefan P Berger, Thomas Jouve, Nikhil Agrawal, Marilda Mazzali, Mathilde Bugnazet, Roman Reindl-Schwaighofer, Saif A. Muhsin, Giorgia Comai, Carlucci Gualberto Ventura, Rainer Oberbauer, Leonardo V. Riella, Alina Morlock, Aileen X. Wang, Enver Akalin, Julio Pascual, Seraina von Moos, Paolo Cravedi, María José Pérez-Sáez, Elias David-Neto, Anna Buxeda, Helio Tedesco-Silva, Carla Burballa, Roberto Ceratti Manfro, Harald Seeger, Het Patel, Juliana Mansur, Luis Sanchez Russo, Omar Alani, Groningen Kidney Center (GKC), Groningen Institute for Organ Transplantation (GIOT), Uffing A., Perez-Saez M.J., Jouve T., Bugnazet M., Malvezzi P., Muhsin S.A., Lafargue M.-C., Reindl-Schwaighofer R., Morlock A., Oberbauer R., Buxeda A., Burballa C., Pascual J., Von Moos S., Seeger H., La Manna G., Comai G., Bini C., Russo L.S., Farouk S., Nissaisorakarn P., Patel H., Agrawal N., Mastroianni-Kirsztajn G., Mansur J., Tedesco-Silva H., Venturae C.G., Agena F., David-Neto E., Akalin E., Alani O., Mazzali M., Manfro R.C., Bauer A.C., Wang A.X., Cheng X.S., Schold J.D., Berger S.P., Cravedi P., and Riella L.V.

Subjects
Adult, Male, medicine.medical_specialty, recurrence, Epidemiology, Biopsy, glomerular disease, graft survival, kidney transplantation, Kidney, IgA deposition, Critical Care and Intensive Care Medicine, Gastroenterology, Antibodies, Nephropathy, Risk Factors, Internal medicine, medicine, Humans, Cumulative incidence, Kidney transplantation, Retrospective Studies, Transplantation, Proportional hazards model, business.industry, Incidence, Incidence (epidemiology), Hazard ratio, Glomerulonephritis, IGA, Retrospective cohort study, Original Articles, IgA nephropathy, Middle Aged, Allografts, medicine.disease, United States, Confidence interval, Europe, Nephrology, Kidney Failure, Chronic, Female, business, Brazil
Abstract

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 donorspecific antibodies (hazardratio, 2.59; 95%confidence interval, 1.09 to 6.19).Afterkidneytransplantation,development of de novo donor-specific antibodies was associated with subsequent higher risk of recurrence of IgA nephropathy (hazard ratio, 6.65; 95% confidence interval, 3.33 to 13.27). Immunosuppressive regimen was not associated with recurrent IgA nephropathy in multivariable analysis, including steroid use. Graft loss was higher in patients with recurrence of IgA nephropathy compared with patients without (hazard ratio, 3.69; 95% confidence interval, 2.04 to 6.66), resulting in 32% (95% confidence interval, 50 to 82) graft loss at 8 years after diagnosis of recurrence.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.

Published
2021

2. Recurrence of FSGS after Kidney Transplantation in Adults

Author

Carlos Arias-Cabrales, Thomas Jouve, María José Pérez-Sáez, Leonardo V. Riella, Enver Akalin, Paolo Cravedi, Stefan P Berger, Kuo-Kai Chin, Carlucci Gualberto Ventura, Xingxing S. Cheng, Paolo Malvezzi, Claudia Bini, Silvia Regina Hokazono, Gilberto M.V. Neto, Audrey Uffing, Mathilde Bugnazet, Saif A. Muhsin, Marilda Mazzali, Anna Buxeda, Roberto Ceratti Manfro, Fabiana Agena, Miguel C. Riella, Nikhil Agrawal, Frederico de Sottomaior Drumond, Gaetano La Manna, Giorgia Comai, Omar Alani, Meredith Haverly, Suraj Sarvode Mothi, Samira S. Farouk, Elias David-Neto, Helio Tedesco-Silva, Michelle M. O’Shaughnessy, Juliana Mansur, Gianna Mastroianni Kirsztajn, Andrea Carla Bauer, Groningen Institute for Organ Transplantation (GIOT), Groningen Kidney Center (GKC), Uffing A., Perez-Saez M.J., Mazzali M., Manfro R.C., Bauer A.C., Drumond F.S., O'shaughnessy M.M., Cheng X.S., Chin K.-K., Ventura C.G., Agena F., David-Neto E., Mansur J.B., Kirsztajn G.M., Tedesco-Silva H., Neto G.M.V., Arias-Cabrales C., Buxeda A., Bugnazet M., Jouve T., Malvezzi P., Akalin E., Alani O., Agrawal N., La Manna G., Comai G., Bini C., Muhsin S.A., Riella M.C., Hokazono S.R., Farouk S.S., Haverly M., Mothi S.S., Berger S.P., Cravedi P., and Riella L.V.

Subjects
Male, Time Factors, Epidemiology, medicine.medical_treatment, kidney disease, 030232 urology & nephrology, graft survival, CHILDREN, 030230 surgery, Critical Care and Intensive Care Medicine, Nephrectomy, DISEASE, FOCAL SEGMENTAL GLOMERULOSCLEROSIS, 0302 clinical medicine, Focal segmental glomerulosclerosis, rituximab, cohort studies, Interquartile range, THERAPEUTIC PLASMA-EXCHANGE, Medicine, risk factors, humans, Kidney transplantation, transplant recipients, Glomerulosclerosis, Focal Segmental, RENAL-TRANSPLANTATION, adult, Hazard ratio, Middle Aged, renal transplantation, kidney diseases, sample size, Europe, risk factor, plasmapheresis, Nephrology, Retreatment, Female, Brazil, Immunosuppressive Agents, Cohort study, medicine.medical_specialty, kidney, recurrence, kidney transplantation, body mass index, ALLOGRAFT, Risk Assessment, 03 medical and health sciences, transplant recipient, Internal medicine, human, Risk factor, Retrospective Studies, plasmapheresi, Transplantation, business.industry, Proportional hazards model, transplant outcomes, Editorials, registries, transplant outcome, medicine.disease, United States, RECIPIENTS, registrie, RESISTANT NEPHROTIC SYNDROME, focal segmental glomerulosclerosi, SAMPLE-SIZE, incidence, treatment outcome, RISK-FACTORS, business, cohort studie
Abstract

Background and objectives FSGS recurrence after kidney transplantation is a major risk factor for graft loss. However, the natural history, clinical predictors, and response to treatment remain unclear because of small sample sizes and poor generalizability of single-center studies, and disease misclassification in registry-based studies. We therefore aimed to determine the incidence, predictors, and treatment response of recurrent FSGS in a large cohort of kidney transplant recipients. Design, setting, participants, & measurements The Post-Transplant Glomerular Disease (TANGO) project is an observational, multicenter, international cohort study that aims to investigate glomerular disease recurrence post-transplantation. Transplant recipients were screened for the diagnosis of idiopathic FSGS between 2005 and 2015 and details were recorded about the transplant, clinical outcomes, treatments, and other risk factors. Results Among 11,742 kidney transplant recipients screened for FSGS, 176 had a diagnosis of idiopathic FSGS and were included. FSGS recurred in 57 patients (32%; 95% confidence interval [95% CI], 25% to 39%) and 39% of them lost their graft over a median of 5 (interquartile range, 3.0–8.1) years. Multivariable Cox regression revealed a higher risk for recurrence with older age at native kidney disease onset (hazard ratio [HR], 1.37 per decade; 95% CI, 1.09 to 1.56). Other predictors were white race (HR, 2.14; 95% CI, 1.08 to 4.22), body mass index at transplant (HR, 0.89 per kg/m2; 95% CI, 0.83 to 0.95), and native kidney nephrectomies (HR, 2.76; 95% CI, 1.16 to 6.57). Plasmapheresis and rituximab were the most frequent treatments (81%). Partial or complete remission occurred in 57% of patients and was associated with better graft survival. Conclusions Idiopathic FSGS recurs post-transplant in one third of cases and is associated with a five-fold higher risk of graft loss. Response to treatment is associated with significantly better outcomes but is achieved in only half of the cases.

Published
2020

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