Long-term outcome of renal transplantation patients with Henoch-Schonlein purpura

Clin J Am Soc Nephrol. 2011 Aug;6(8):2034-40. doi: 10.2215/CJN.01410211. Epub 2011 Jun 23.

Abstract

Background and objectives: Although Henoch-Schönlein purpura (HSP) is the most common form of renal vasculitis in childhood, progression to ESRD is rare, and there are few data on outcomes of renal transplantation in patients with HSP.

Design, setting, participants, & measurements: This is a matched retrospective cohort study of renal allografts using the United Network of Organ Sharing database (1987 to 2005). Of the 189,211 primary renal allografts, there were 339 with a diagnosis of HSP. The primary end point was allograft survival.

Results: Compared with the remainder of the database, the HSP population was younger (25 years versus 46 years), and had a higher proportion of women (47% versus 40%), live donors (50% versus 35%), and Caucasians (77% versus 60%). Controlling for age, gender, donor source, ethnicity, and year of transplantation, death-censored graft survival for patients with HSP was 80.0% at 5 years and 58.8% at 10 years compared with 79.0% at 5 years and 55.4% at 10 years in the non-HSP population. Among patients with reported causes of graft loss, failure from recurrent disease occurred in 13.6% of patients with HSP, compared with 6.6% in the non-HSP population. When analyzing allograft survival in recipients with HSP compared with those with IgA nephropathy, there was no difference in 10-year allograft survival (58.4% and 59.3%, respectively).

Conclusions: These data indicate that although there is an increased risk of graft failure attributable to recurrent disease in patients with HSP, a diagnosis of HSP has little effect on overall renal allograft survival.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Databases as Topic
  • Disease Progression
  • Female
  • Glomerulonephritis, IGA / complications
  • Glomerulonephritis, IGA / surgery
  • Graft Survival*
  • Humans
  • Infant
  • Infant, Newborn
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation* / adverse effects
  • Kidney Transplantation* / mortality
  • Male
  • Middle Aged
  • Purpura, Schoenlein-Henoch / complications
  • Purpura, Schoenlein-Henoch / mortality
  • Purpura, Schoenlein-Henoch / surgery*
  • Recurrence
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Tissue and Organ Procurement
  • Treatment Outcome
  • United States / epidemiology
  • Young Adult