Antithymocyte Globulin (ATG) Induction Therapy and Disease Recurrence in Renal Transplant Recipients With Primary IgA Nephropathy

Abstract

Recurrence of primary IgA nephropathy after renal transplantation is clearly a time-dependent event, justifying the use of Kaplan-Meier and Cox regression analyses to sort the significant risk factors. In this retrospective study, we focused on the potential role of induction immunosuppressive therapy. We studied 116 renal transplantation (84 males, 112 cadaveric donors, 95 first grafts, mean age at Tx=46.1 years) who received, as induction, antithymocyte globulin (ATG) in 29, anti-CD25 in 35, and none in 52, associated with different maintenance therapy overtime. The 10-year cumulative recurrence rate was overall 36%, but only 9% after ATG induction when compared with 41% without induction (P=0.001). Multivariate Cox regression confirmed that ATG was protective with a 80% reduction in relative risk (P=0.01). In conclusion, this important finding needs to be confirmed in a prospective trial and if so will have major implication.

Recurrence and Graft Loss after Kidney Transplantation for Henoch–Schönlein Purpura Nephritis

“…Indeed, there was no difference between azathioprine and mycophenolate mofetil or between cyclosporine and tacrolimus in the risk of graft failure caused by recurrence (18). In contrast, Berthoux et al (19) reported a protective role of anti-thymocyte globulins induction therapy in IgAN recurrence. In our population, we did not observe a statistically significant difference in immunosuppressive treatment between patients who relapsed and patients who did not (Table 2).…”

Posttransplant Recurrence of Primary Glomerulonephritis

“…There is now general agreement that the type and intensity of posttransplant immunosuppression does not influence the risk of IgAN recurrence. However, Berthoux et al (29) recently reported that the 10-year cumulative recurrence rate of IgAN was 9% (3 of 29) in patients who received induction with anti-thymocyte globulins versus 41% (21 of 52) in patients who did not receive such induction therapy. The authors hypothesized that the protective effect of anti-thymocyte globulins could be related to an augmented production of regulatory T cells.…”

Primary IgA Nephropathy: An Update in 2011

“…The factors associated to recurrence are not well understood: living donors, better HLA matching, short duration of the original disease, etc. There is yet no specific treatment for the recurrent disease; however in a retrospective study [56] we demonstrated that induction treatment with ATG seems able to reduce the incidence of recurrence in comparison to no induction or to induction with Basiliximab. A prospective randomized controlled trial comparing rabbit ATG to Basiliximab has already started, the PIRAT study: Prevention in IgA nephropathy recipients of full Recurrence After renal Transplantation according to induction immunosuppressive therapy: ATG versus Basiliximab.…”

“…First, a silent IgA nephropathy can be present on grafted kidney from apparently normal donors leading to the discovery of mesangial IgA deposits on graft biopsies performed early after transplantation; it was demonstrated in few cases that these deposits can regress and disappear demonstrating a contrario that the disease has a systemic (blood) transmission. Second, the original disease may reappear (recurrence) on the normal grafted kidney after few years and despite immunosuppression [51][52][53][54][55][56][57][58][59]. The cumulative incidence of clinicpathological recurrence is high reaching 35 % or more at 10 years post-transplant [56] and may lead to graft losses in up to 17 % at 10 y [57].…”

“…Second, the original disease may reappear (recurrence) on the normal grafted kidney after few years and despite immunosuppression [51][52][53][54][55][56][57][58][59]. The cumulative incidence of clinicpathological recurrence is high reaching 35 % or more at 10 years post-transplant [56] and may lead to graft losses in up to 17 % at 10 y [57]. The factors associated to recurrence are not well understood: living donors, better HLA matching, short duration of the original disease, etc.…”