Clinical importance of the updated Oxford classification in allograft IgA nephropathy

Abstract

With the recent update to the Oxford classification for allograft IgA nephropathy (IgAN), additional investigations on the clinical significance of the updated components are warranted. We performed a retrospective cohort study at two tertiary hospitals. Kidney transplant recipients diagnosed with allograft IgAN were included in the study after additional review by specialized pathologists. We applied the updated Oxford classification and determined the MEST-C scores of the patients. The main study outcome was death-censored graft failure within 10 years after the establishment of allograft IgAN diagnosis and was assessed using the Cox regression analysis.Three hundred thirty-three allograft IgAN patients were reviewed: 100 patients with confirmed native IgAN and 233 patients with other, clinical, or unknown primary causes for end-stage renal disease (ESRD). The updated Oxford classification for allograft IgAN demonstrated prognostic value for graft failure, and patients with multiple MEST-C components had worse outcomes. M, E, S, and C were significantly associated with the prognosis of recurred IgAN and T was the only independent prognostic parameter for allograft IgAN without confirmed native IgAN. Therefore, we suggest reporting MEST-C scores in allograft biopsies and careful interpretation of the results according to the primary cause of ESRD. K E Y W O R D Sclinical research/practice, glomerular biology and disease, graft survival, kidney (allograft) function/dysfunction, kidney disease: immune/inflammatory, kidney transplantation/ nephrology, pathology/histopathology, recurrent disease

Recurrence of immunoglobulin A nephropathy after kidney transplantation: a narrative review of the incidence, risk factors, pathophysiology and management of immunosuppressive therapy

“…However, given the retrospective nature of the study, only 41 biopsies were tested for C4d and donor-specific antibody status was unknown, thus underestimating the possible role of concurrent acute or chronic antibody-mediated rejection on the pathogenesis of the lesions. Park et al [ 78 ] recently published on the same topic, describing the prognostic importance of the MEST-C classification in a cohort of 333 patients with IgAN in their graft. They found that all the components of the updated IgAN classification system were significantly associated with prognosis.…”

Possible beneficial association between renin-angiotensin-aldosterone-system blockade usage and graft prognosis in allograft IgA nephropathy: A retrospective cohort study

“…Still, it should be noted that the possible benefits of single agent RAASB over single BB or CCB was not confirmed herein for the recurred IgAN cases with confirmed native IgAN. In our previous study, the clinical significance of the Oxford classification was different according to allograft IgAN subtypes [20]. In allograft IgAN with confirmed native IgAN cases, M, E, S, and C components, which may reflect intraglomerular disease activity, were important prognostic parameters, but in the cases without confirmed native IgAN, only the T was a significant pathologic risk factor.…”

“…Information on coexisting evidence of acute rejection was also recorded from the pathology reports. Specialized pathologists additionally reviewed the updated Oxford classification, which showed clinical significance also in allograft IgAN [20], in the pathology slides including; M (mesangial hypercellularity), E (endocapillary hypercellularity), S (segmental sclerosis), T (interstitial fibrosis or tubular atrophy), and C (cellular or fibrocellular crescent formation). There were missing cases regarding the Oxford classification because some slides were missing and some were at insufficient quality for additional pathology review.…”

“…In this study, we aimed to provide supporting evidence for the possible benefits of RAASB in allograft IgAN. We reviewed our retrospective cohort of allograft IgAN patients and identified their prescribed hypertensive medication categories [8,20]. We then compared their prognosis in terms of death-censored-graft-failure (DCGF) and changes in albuminuria levels.…”

Possible beneficial association between renin-angiotensin-aldosterone-system blockade usage and graft prognosis in allograft IgA nephropathy: A retrospective cohort study

“…In this study, we aimed to provide supporting evidence for the potential benefits of RAASB in allograft IgAN. We reviewed our retrospective cohort of allograft IgAN patients and identified their prescribed hypertensive medication categories [8,20]. We then compared their prognosis in terms of deathcensored-graft-failure (DCGF) and changes in albuminuria levels.…”