Recurrence of IgA Nephropathy after Kidney Transplantation in Adults
In a large international cohort, recurrent IgA nephropathy occurred in roughly a quarter of kidney transplant recipients over long-term follow-up and was associated with a substantially higher risk of graft loss; pre-emptive transplantation and donor-specific antibodies emerged as key risk factors.
Background
IgA nephropathy is a leading cause of end-stage kidney disease, and IgA deposits can recur in a subsequent kidney transplant. Prior estimates of the incidence, impact, and risk factors of recurrence have been limited by single-centre studies with relatively small sample sizes.
Study design
This was a multicenter, international, retrospective study within the Post-Transplant Glomerular Disease consortium, collecting data on consecutive patients with biopsy-proven IgA nephropathy transplanted between 2005 and 2015 across 16 centres in Europe, North America, and South America. Recurrence was identified by kidney biopsy among 504 transplant recipients.
Key findings
Recurrent IgA deposits were identified in 82 of 504 patients, with a cumulative incidence of recurrence of 23% at 15 years. Higher risk of recurrence was seen in patients with a pre-emptive transplant (hazard ratio 3.45) and those with preformed donor-specific antibodies (hazard ratio 2.59); development of donor-specific antibodies after transplant was associated with an even higher recurrence risk (hazard ratio 6.65). Immunosuppressive regimen, including steroid use, was not associated with recurrence in multivariable analysis. Graft loss was higher with recurrence (hazard ratio 3.69), reaching about 32% graft loss at 8 years after diagnosis of recurrence.
Clinical implications
Recurrent IgA nephropathy is a clinically important cause of allograft loss, and its association with both preformed and de novo donor-specific antibodies suggests a role for closer immunologic monitoring in these recipients. These findings support vigilance for recurrence, particularly in younger patients and those transplanted pre-emptively.
Category
Transplant
Source
CJASN
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