Recurrence of iga nephropathy after kidney transplantation in adults

Audrey Uffing, Maria José Pérez-Saéz, Thomas Jouve, Mathilde Bugnazet, Paolo Malvezzi, Saif A. Muhsin, Marie Camille Lafargue, Roman Reindl-Schwaighofer, Alina Morlock, Rainer Oberbauer, Anna Buxeda, Carla Burballa, Julio Pascual, Seraina Von Moos, Harald Seeger, Gaetano La Manna, Giorgia Comai, Claudia Bini, Luis Sanchez Russo, Samira FaroukPitchaphon Nissaisorakarn, Het Patel, Nikhil Agrawal, Gianna Mastroianni-Kirsztajn, Juliana Mansur, Hélio Tedesco-Silva, Carlucci Gualberto Venturaé, Fabiana Agena, Elias David-Neto, Enver Akalin, Omar Alani, Marilda Mazzali, Roberto Ceratti Manfro, Andrea Carla Bauer, Aileen X. Wang, Xingxing S. Cheng, Jesse D. Schold, Stefan P. Berger, Paolo Cravedi, Leonardo V. Riella

Research output: Contribution to journalArticlepeer-review

Abstract

Background and objectives In patients with kidney failure due to IgA nephropathy, IgA deposits can recur in a subsequent kidney transplant. The incidence, effect, and risk factors of IgA nephropathy recurrence is unclear, because most studies have been single center and sample sizes are relatively small. Design, setting, participants, & measurementsWe performed a multicenter, international, retrospective study to determine the incidence, risk factors, and treatment response of recurrent IgA nephropathy after kidney transplantation. Data were collected from all consecutive patients with biopsy-proven IgA nephropathy transplanted between 2005 and 2015, across 16 “The Post-Transplant Glomerular Disease” study centers in Europe, North America, and South America. Results Out of 504 transplant recipients with IgA nephropathy, recurrent IgA deposits were identified by kidney biopsy in 82 patients; cumulative incidence of recurrence was 23% at 15 years (95% confidence interval, 14 to 34). Multivariable Cox regression revealed a higher risk for recurrence of IgA deposits in patients with a pre-emptive kidney transplant (hazard ratio, 3.45; 95% confidence interval, 1.31 to 9.17) and in patients with preformed donorspecific antibodies (hazardratio, 2.59; 95%confidence interval, 1.09 to 6.19).Afterkidneytransplantation,development of de novo donor-specific antibodies was associated with subsequent higher risk of recurrence of IgA nephropathy (hazard ratio, 6.65; 95% confidence interval, 3.33 to 13.27). Immunosuppressive regimen was not associated with recurrent IgA nephropathy in multivariable analysis, including steroid use. Graft loss was higher in patients with recurrence of IgA nephropathy compared with patients without (hazard ratio, 3.69; 95% confidence interval, 2.04 to 6.66), resulting in 32% (95% confidence interval, 50 to 82) graft loss at 8 years after diagnosis of recurrence. Conclusions In our international cohort, cumulative risk of IgA nephropathy recurrence increased after transplant and was associated with a 3.7-fold greater risk of graft loss.

Original languageEnglish (US)
Pages (from-to)1247-1255
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume16
Issue number8
DOIs
StatePublished - Aug 2021

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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