Renal transplantation in patients with primary immunoglobulin A nephropathy.
BACKGROUND
Opinions on the clinical course and outcome of renal transplantation in patients with primary immunoglobulin A nephropathy (IgAN) have been controversial.


METHODS
We conducted a retrospective single-centre study on 542 kidney transplant recipients over the period 1984-2001. Long-term outcome and factors affecting recurrence in recipients with primary IgAN were analysed.


RESULTS
Seventy-five patients (13.8%) had biopsy-proven IgAN as the cause of renal failure, and their mean duration of follow-up after transplantation was 100 +/- 5.8 months. Fourteen (18.7%) of the 75 patients had biopsy-proven recurrent IgAN, diagnosed at 67.7 +/- 11 months after transplantation. The risk of recurrence was not associated with HLA DR4 or B35. Graft failure occurred in five (35.7%) of the 14 patients: three due to IgAN and two due to chronic rejection. Three (4.9%) of the 61 patients without recurrent IgAN had graft failure, all due to chronic rejection. Graft survival was similar between living-related and cadaveric/living-unrelated patients (12-year graft survival, 88 and 72%, respectively, P = 0.616). Renal allograft survival within the first 12 years was better in patients with primary IgAN compared with those with other primary diseases (80 vs 51%, P = 0.001). Thereafter, IgAN patients showed an inferior graft survival (74 vs 97% in non-IgAN patients, P = 0.001).


CONCLUSIONS
Our data suggested that around one-fifth of patients with primary IgAN developed recurrence by 5 years after transplantation. Recurrent IgA nephropathy in allografts runs an indolent course with favourable outcome in the first 12 years. However, the contribution of recurrent disease to graft loss becomes more significant on long-term follow up.
Choy
Bo Ying
BY
Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
Chan
Tak Mao
TM
Lo
Sing Kai
SK
Lo
Wai Kei
WK
Lai
Kar Neng
KN
D000328:Adult; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control*; D006084:Graft Rejection / Q000503:physiopathology; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D012189:Retrospective Studies; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome