Evaluating the clinical course and prognostic factors of posttransplantation immunoglobulin A nephropathy

Transplant Proc. 2008 Sep;40(7):2349-54. doi: 10.1016/j.transproceed.2008.07.008.

Abstract

Introduction: Previous reports have suggested that posttransplantation immunoglobulin (Ig) A nephropathy displays a relatively benign course, hardly ever affecting graft function. However, more recent studies with longer follow-up have shown that posttransplantation IgA nephropathy may be a significant contributor to graft loss. Additionally, there may be other clinical or pathological factors that affect long-term graft outcome. We retrospectively analyzed 30 kidney transplant recipients with biopsy-proven IgA nephropathy in their allografts to determine the clinical course and prognostic factors in posttransplantation IgA nephropathy. The median duration of follow-up was 36 months (range, 1 month-17 years). The median onset of IgA nephropathy was 33.6 months posttransplantation (range, 5 days-103 months). The most common presentation was an abnormal urine examination (96.6%). Fifteen (50%) displayed microscopic hematuria with proteinuria more than 1 g/d. Fifteen patients (50%) lost their grafts at a median time of 24 months after the onset of disease (range, 1-93 months). Allograft loss was associated with a high serum creatinine level at the time of diagnosis (3.68 +/- 2.23 vs 1.79 +/- 0.34 mg/dL; P = .006), a greater level of proteinuria at the time of diagnosis (2.43 +/- 0.76 vs 1.29 +/- 1.07 g/d; P = .003), and more than 50% extracapillary proliferation (P = .05). Fibrinoid necrosis on allograft pathology impacted 1-year allograft survival (P = .025).

Conclusion: Posttransplantation IgA nephropathy worsens allograft outcomes among patients with increased serum creatinine level or significant proteinuria at presentation or significant glomerular inflammation and/or tubulointerstitial damage.

MeSH terms

  • Adult
  • Blood Pressure
  • Cadaver
  • Creatinine / blood
  • Female
  • Follow-Up Studies
  • Glomerulonephritis, IGA / etiology*
  • Glomerulonephritis, IGA / physiopathology*
  • HLA Antigens / immunology
  • Histocompatibility Testing
  • Humans
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / immunology
  • Living Donors
  • Male
  • Middle Aged
  • Prognosis
  • Proteinuria / etiology
  • Retrospective Studies
  • Time Factors
  • Tissue Donors

Substances

  • HLA Antigens
  • Creatinine