1. Recurrence of iga nephropathy after kidney transplantation in adults
- Author
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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