title: Recurrence of IgA nephropathy among renal allograft recipients from living donors is greater among those with zero HLA mismatches.
abstract: BACKGROUND
  Risk factors contributing to recurrence of IgA nephropathy (IgAN) after transplantation are unclear. Some (but not all) series have suggested greater degrees of human leukocyte antigen (HLA) matching play a role.
  
  
  METHODS
  Using registry data including all kidney transplants performed in Australia and New Zealand between 1987 and 2004 we examined IgAN recurrence among living donors with zero HLA-mismatches.
  
  
  RESULTS
  Of 1354 grafts performed in recipients with IgAN, live donors (LDs) accounted for 488 including 108 with zero HLA-mismatches. Biopsy-proven IgAN recurrence was reported for 110 (7%) of grafts overall, but 17% of those who received zero HLA-mismatched LD grafts (HR for recurrence free graft survival 2.7 [95% CI 1.5-5.1], P=0.001). There was no significant difference in recurrence rates between zero and >or=1 HLA-mismatched grafts from cadaveric donors (CDs). Recurrence of IgAN was associated with worse graft survival, more so among LD recipients (HR 8.5 [4.8-15.2], P<0.001) than CD recipients (HR 4.5 [2.6-7.5], P<0.001). However, there was no difference in graft survival between zero and >or=1 HLA mismatched LD recipients whose native disease was IgAN. In contrast, zero HLA mismatched recipients of kidneys with other primary renal disease enjoyed a graft survival advantage. No difference in recurrence rates was seen among those with HLA B12, B35 or DR4.
  
  
  CONCLUSIONS
  The increased rates of IgAN-related graft loss among zero HLA-mismatched LD recipients counterbalance the advantage normally seen among zero HLA-mismatched recipients. However, since graft survivals are similar, there is no reason to avoid donor-recipient pairs with zero HLA-mismatches in this setting.
authors.affiliation: ANZDATA Registry, Adelaide, Australia. stephenm@anzdata.org.au
authors.forename: Stephen P
authors.initials: SP
authors.lastname: McDonald
authors.forename: Graeme R
authors.initials: GR
authors.lastname: Russ
mesh_terms: D001315:Australia / Q000453:epidemiology; D005260:Female; D005922:Glomerulonephritis, IGA / Q000453:epidemiology* / Q000276:immunology; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome