Recurrent glomerulonephritis after kidney transplantation: risk factors and allograft outcomes

Abstract

Recurrent glomerulonephritis after kidney transplantation is a feared complication because it is unpredictable and may have a negative impact on graft outcomes. To better understand this we collected data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry accumulated over 30 years. The incidence, risk factors, and outcomes of recurrent glomerulonephritis in transplant recipients were determined using adjusted Cox proportional hazard and competing risk modeling. A total of 6,597 recipients with biopsy-proven glomerulonephritis as the primary cause of end-stage kidney disease were followed for 51,871 person-years (median duration 7.7 years). The four most common types of glomerulonephritis were IgA nephropathy in 2501 patients, focal segmental glomerulosclerosis (FSGS) in 1403, membranous in 376, and membranoproliferative (MPGN) nephropathy in 357 patients. Among these four types, recurrence was reported in 479 of 4637 patients, and of these, 212 lost their allograft due to recurrence. Older age at transplantation (adjusted hazard ratio [per year increase] 0.96 [95% confidence interval 0.95 - 0.97]) was associated with a lower risk of recurrence. Significantly, the five-year graft survival was 30% for recipients with recurrent MPGN and 57-59% for recipients with FSGS, IgA, and membranous nephropathy. Transplant recipients with recurrent disease were twice as likely to lose their allografts compared to those without recurrence (adjusted hazard ratio 2.04 [1.81-2.31]). Thus, recurrent glomerulonephritis remains a significant cause of graft loss in transplant recipients.

The impact of donor/recipient age difference and HLA mismatch on graft outcome in pediatric kidney transplantation

“…Increasing recipient age at the time of transplant was negatively correlated with long‐term graft outcomes, likely a reflection of an increased graft loss in adolescent and young adult recipients as shown in a recent ANZDATA report . Non‐Caucasian patients and those with GN also had poorer outcomes, in keeping with previous ANZDATA studies …”

“…39 Non-Caucasian patients and those with GN also had poorer outcomes, in keeping with previous ANZDATA studies. [40][41][42][43] The strengths of our study are a large sample size, completeness of data collection, and minimal loss of patients over long-term follow-up. However, the relatively small number of recipients in some subgroups of interest limited our ability to assess the impact of these factors on long-term graft outcome.…”

Clinical features and outcomes of kidney transplant recipients with focal segmental glomerulosclerosis recurrence

“…Despite excellent patient survival, FSGSr is associated with poor 50% 5 years graft survival. 3,[50][51][52][53] A large 20 years retrospective cohort study in kidney transplant recipients with primary FSGS found a 52% 5 years graft survival in the recurrence group compared with 83% in the group without recurrent disease. 54 This retrospective nature of this study is inherently associated with several limitations.…”

TESTING Corticosteroids in IgA Nephropathy

“…Long-term data show that 20%-40% of patients progress to ESRD within 10-20 years of diagnosis. Recurrence of IgA deposition in the transplanted kidney is common, despite patients being on immunosuppression, and is an important cause of graft failure (1). Clinical features, including hypertension and proteinuria, have been shown to be useful in assessing prognosis.…”

“…In the absence of clear evidence, it is not easy to recommend an optimum treatment protocol. The way forward may be to deliver more specific therapy by (1) targeting the relevant lymphoid tissue, or (2) inhibiting selective immune mechanisms. Recently, targeted release of budesonide was tested in the Targeted-Release Budesonide Versus Placebo in Patients with IgA Nephropathy (NEFIGAN), a phase 2b trial (9).…”