Recurrent IgA nephropathy following kidney transplantation in Chinese: not a benign prognosis

Ji Shu�Ming; Chen Jin�Song; Wen Ji�Qiu; Cheng Dong�Rui

Volume : VI, Issue : IV, April - 2016

Recurrent IgA nephropathy following kidney transplantation in Chinese: not a benign prognosis

Ji Shu Ming , Chen Jin Song, Wen Ji Qiu , Cheng Dong Rui

Abstract :

Objective: The aims of this study were to determine the incidence of immunoglobin A nephropathy(IgAN) recurrence assessed by protocol biopsies and to identify predictive factors including pathological and clinical characteristics following kidney transplantation in China. Methods: Of the 148 recipients of allografts for end–stage renal disease caused by primary IgA nephropathy between January 1996 and April 2009 at our institution. Reccurent IgAN was found in 46 patients out of 148 renal biopsy from allogaft kidneys. Biopsies were taken at a median time of 9.3 ±3.6 months after transplantation. Results: 46 patients (31.1%) had biopsy–conårmed recurrent IgAN. The urinary red blood cell sediment?U–RBC?and proteinuria at 5 yr after transplantation differed signiåcantly between recurrent IgAN group and non–recurrent IgAN group, respectively,180±27 vs. 10±5 M/ml and 2.6±0.51 vs. 0.4±0.2 g/d. Serum creatinine(SCr) levels at 5 yr after transplantation was signiåcantly higher in the recurrent IgAN group than in the non–recurrent IgAN group(4.52±1.61 vs. 1.19±0.20 mg/dl). Glomerular åltration rate was signiåcantly lower in the recurrent IgAN group than in the non–recurrent IgAN group at 5 yr after transplantation: 30.24±9.04 vs. 68.58 ml/min. The prevalence of cellular crescents, glomeruli with adhesions, mesangial cell proliferation, mesangial matrix increase, global sclerosis and glomeruli with segmental sclerosis was signiåcantly greater in the reccurent IgAN group than in the non–reccurent IgAN group(P<0.001), The rate of global obsolescence and the average score of interstitial åosis in the reccurent IgAN group were signiåcantly greater than in the non–reccurent IgAN group(P<0.001). Ten recipients(21.7%) among the 46 patients with recurrent IgAN progressed to graft loss within 5 yr after transplantation. Graft survival both groups was no signiåcant, respectively 93.8% and 95.6% in 1 year and 86.7% and 88.3% in 3 years. 5 years graft survival rate was lower in the reccurent IgAN group than in the non–reccurent IgAN group (51.4% vs. 83.8%, p< 0.001). The grade of chronic rejection was tended to be higher in the graft loss group than in the graft survival group. Interestingly, incidences of latent IgA deposition from the donor kidney was higher in the graft loss group than in the graft survival group. Conclusion: Recurrent IgA nephropathy following renal transplantation is not a benign prognosis in Chinese. Our data suggest that 31.1% out of patients with primary IgAN will develop recurrence, 21.7% among the 46 patients with recurrent IgAN progressed to graft loss within 5 yr after transplantation. Latent IgA deposition from the donor kidney was one of the risk factors of recurrent IgAN progressed to graft loss.