The long-term outcome of renal transplantation of IgA nephropathy and the impact of recurrence on graft survival

Nephrol Dial Transplant. 2013 May;28(5):1305-14. doi: 10.1093/ndt/gfs472. Epub 2012 Dec 9.

Abstract

Background: Few data are available on allograft survival at 15 years, the impact and the predictors of recurrence of the original disease in renal transplanted patients with IgA nephropathy (IgAN).

Methods: In this retrospective study, we compared the long-term outcome of renal transplant in 190 patients with IgAN with that of 380 non-diabetic controls and evaluated the impact of recurrence of IgAN on the graft outcome.

Results: At 15 years, the patient survival was 88.3% in IgAN patients and 82.6% in controls (P = 0.12), while the death-censored graft survival was 62.6 and 72.4%, respectively (P = 0.038). IgAN had a higher cumulative incidence of graft failures in comparison with controls even considering death as a competing risk (P = 0.025). At multivariate analysis, IgAN [relative risk (RR) = 1.468, P = 0.026], delayed graft function recovery (RR = 2.394, P = 0.000) and acute rejection (RR = 2.51, P = 0.000) were predictive of graft loss. IgAN recurred in 42 grafts (22.1%), of them, 12 were lost for recurrence and in another 6 recurrence was considered a concomitant cause of graft loss. The 15-year death censored graft survival was 68.3% in non-recurrent and 51.2% in recurrent patients (P = 0.069). Pure graft survival of non-recurrent IgAN patients was similar to that of controls (P = 0.406). At Cox analysis, the recurrence of IgAN significantly reduced from 1981 to 2010 (P = 0.0065, RR = 0.936).

Conclusions: IgAN emerged as an independent predictor of worse graft outcome in the long-term. Recurrence of IgAN seems to progressively reduce in transplants performed from 1981 to 2010.

Keywords: IgA nephropathy; recurrent glomerulonephritis; renal transplantation.

Publication types

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

MeSH terms

  • Adult
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Glomerulonephritis, IGA / complications*
  • Glomerulonephritis, IGA / mortality
  • Glomerulonephritis, IGA / therapy
  • Graft Rejection / etiology
  • Graft Rejection / mortality*
  • Graft Rejection / prevention & control*
  • Graft Survival
  • Humans
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Prognosis
  • Recurrence
  • Retrospective Studies
  • Survival Rate
  • Transplantation, Homologous