title: Impact of posttransplantation glomerulonephritis on long-term outcome of kidney transplants: single-center 20-year experience.
abstract: BACKGROUND
  Successful renal transplantation has been performed in patients with end-stage renal disease and has been routine in patients with end-stage renal failure for more than two decades. Despite advances in the use of immunosuppressants, there has been only modest improvement in long-term allograft survival. Accumulating data have demonstrated that chronic rejection and recurrent glomerulonephritis are major causes of long-term allograft loss. However, data regarding the long-term impact of posttransplantation glomerulonephritis (PTGN) on ethnic Chinese populations are still unavailable.
  
  
  METHODS
  From 1984 to 2010, a total of 268 patients who underwent renal allograft biopsies were reviewed retrospectively. Renal outcomes were compared by Kaplan-Meier analysis, and risk factors for renal survival and all-cause mortality were analyzed using the Cox proportional hazards model.
  
  
  RESULTS
  In all, 85 patients (31.7%) had PTGN, and the mean time of disease onset was 5.32±5.18 years after transplantation. Among the 85 PTGN cases, 33 (39%) were immunoglobulin A (IgA) nephropathy, 24 (28%) were focal segmental glomerulosclerosis, and 8 (9.4%) were membranous GN. Significant risk was associated with posttransplant IgA GN in hepatitis B virus carriers (odds ratio 5.371, 95% confidence interval 1.68, 17.19; p=0.0064). A total of 45 PTGN patients had allograft loss, of whom 49% had IgA nephropathy. Patients with PTGN had inferior allograft survival rates compared to those with other pathologic findings (p<0.0003).
  
  
  CONCLUSIONS
  Taken together, our results indicate that PTGN had a strong negative impact on long-term kidney graft survival. Posttransplant IgA nephropathy is a leading cause of allograft loss in Chinese kidney transplant patients with PTGN.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, and Graduate Institute of Clinical Medical Science, China Medical University, 160 Chung-Kang Road, Section 3, Taichung, Taiwan. yu5523@gmail.com
authors.forename: Tung-Min
authors.initials: TM
authors.lastname: Yu
authors.forename: Mei-Chin
authors.initials: MC
authors.lastname: Wen
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Wu
authors.forename: Cheng-Hsu
authors.initials: CH
authors.lastname: Chen
authors.forename: Chi-Hung
authors.initials: CH
authors.lastname: Cheng
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Li
authors.forename: Kuo-Hsiung
authors.initials: KH
authors.lastname: Shu
mesh_terms: D000328:Adult; D044466:Asian People; D002681:China; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000208:ethnology / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000208:ethnology / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000208:ethnology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome