title: IgA nephropathy recurs early in the graft when assessed by protocol biopsy.
abstract: BACKGROUND
  The recurrence of IgA nephropathy (IgAN) in the allograft is common. Factors related to IgA recurrence are unclear. The aims of this study were to determine the incidence of IgAN recurrence as assessed by protocol biopsies and to identify predictive factors for recurrence.
  
  
  METHODS
  We identified 65 protocol biopsies taken before the second year post-transplantation in patients with IgAN as primary renal disease. Diagnosis of recurrence of IgA was based on the detection of at least 1+ mesangial deposits of IgA. Pathological findings and clinical characteristics were retrospectively compared between recurrent and non-recurrent cases.
  
  
  RESULTS
  IgAN recurrence rate was 32%. Mesangial C3 was detected in 83% of recurrent cases versus 17% in non-recurrent patients (P < 0.001). Normal urinalysis was observed in 52%. Non-recurrent patients had arteriolar hyalinosis in 31% of the cases versus none in IgAN recurrence (P = 0.006). Seventy-nine per cent of cyclosporine users were free of recurrence, whereas 45% of the patients without cyclosporine experienced recurrence (P = 0.03). The odds ratio (OR) for IgAN recurrence in patients using cyclosporine was 0.3 (confidence interval 0.1-0.9). Zero HLA-DR mismatch was associated with non-recurrence (P < 0.01). The OR for IgA recurrence was 6.7 if any degree of DR mismatch was present. IgAN recurrent patients had better glomerular filtration rate, but after censoring delayed graft function, the differences disappeared. Graft loss due to IgA recurrence was only 3%.
  
  
  CONCLUSIONS
  IgAN recurrence rate was 32%. The histological diagnosis was not accompanied by abnormalities in the urinalysis in one-half of the patients. Full DR match and cyclosporine were associated with non-recurrence.
authors.affiliation: Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland. fernanda.ortiz@hus.fi
authors.forename: Fernanda
authors.initials: F
authors.lastname: Ortiz
authors.forename: Rosana
authors.initials: R
authors.lastname: Gelpi
authors.forename: Petri
authors.initials: P
authors.lastname: Koskinen
authors.forename: Anna
authors.initials: A
authors.lastname: Manonelles
authors.forename: Anne
authors.initials: A
authors.lastname: Räisänen-Sokolowski
authors.forename: Marta
authors.initials: M
authors.lastname: Carrera
authors.forename: Eero
authors.initials: E
authors.lastname: Honkanen
authors.forename: Josep M
authors.initials: JM
authors.lastname: Grinyó
authors.forename: Josep M
authors.initials: JM
authors.lastname: Cruzado
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000175:diagnosis* / Q000209:etiology*; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence