Evaluation of the Modified Oxford Score in Recurrent IgA Nephropathy in North American Kidney Transplant Recipients: The Banff Recurrent Glomerulonephritis Working Group Report
In a North American cohort from the Banff Recurrent Glomerulonephritis Working Group, the modified Oxford (MEST-C) classification predicted graft failure in kidney transplant recipients with recurrent IgA nephropathy, supporting its inclusion in allograft biopsy reports.
Background
IgA nephropathy is the most common glomerulonephritis worldwide and frequently recurs after kidney transplantation, where it contributes to graft loss. The modified Oxford MEST-C classification (mesangial and endocapillary hypercellularity, segmental sclerosis, interstitial fibrosis/tubular atrophy, and crescents) had previously been shown to predict graft failure in Asian recipients with recurrent disease, but this had not been validated in North American populations.
Study design
The Banff Recurrent Glomerulopathies Working Group examined 171 transplant recipients with end-stage kidney disease due to IgA nephropathy: 100 with biopsy-proven recurrence (57 with complete MEST-C scores) and 71 without recurrence. Death-censored graft failure was the principal outcome, analyzed in relation to recurrence status and individual and summed MEST-C components.
Key findings
Recurrence of IgA nephropathy was associated with younger age at transplantation and strongly increased the risk of death-censored graft failure (adjusted hazard ratio 5.10; 95% CI 2.26 to 11.51). Higher summed MEST-C scores were associated with progressively greater risk (adjusted hazard ratios 8.57 for sums of 2 to 3 and 61.32 for sums of 4 to 5 versus 0), and endocapillary hypercellularity, interstitial fibrosis/tubular atrophy, and crescents were each independently predictive. The estimates were largely consistent with those reported in the prior Asian cohort.
Clinical implications
These findings validate the prognostic value of the modified Oxford classification for recurrent IgA nephropathy in a North American transplant population and support routinely reporting the MEST-C score on allograft biopsies. Doing so may help identify recipients at higher risk of graft loss who could benefit from closer monitoring or intensified therapy.
Category
Transplant
Source
Transplantation
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