Glomerular disease recurrence in second and subsequent kidney transplants.
BACKGROUND
Primary glomerular diseases such as primary focal segmental glomerular sclerosis (FSGS), IgA Nephropathy and membrano-proliferative glomerulonephritis (MPGN) may recur in renal transplants, and can potentially lead to graft failure. The rate of recurrence in second and subsequent renal transplants, following failure of the first graft due to recurrence, is unclear.


METHODS
A retrospective review of the Irish transplant database from 1982 to 2009 was performed. Patients were included for analysis if their first graft failed due to biopsy-confirmed recurrent glomerular disease (primary FSGS, IgA nephropathy or MPGN) and they underwent subsequent re-transplantation.


RESULTS
3,330 deceased and living renal transplants were performed during the time period in question. 33 patients had a deceased donor renal transplant following recurrence of primary FSGS, IgA nephropathy or MPGN causing first graft failure. Clinically significant disease recurrence was seen in 44% of re-transplants at 10 years. Median second graft survival in this group was 9.1 years. The median graft survival was 10.5 years for all other re-transplants performed in Ireland during the same time period.


CONCLUSIONS
Clinically significant disease recurrence does not necessarily affect re-transplants following loss of the first graft to disease recurrence. Selected patients who experience first graft failure due to recurrent glomerular disease should not be precluded from receiving a second transplant.
Department of Nephrology, Beaumont Hospital, Dublin, Ireland. kennedyclaire@gmail.com
Claire
C
Kennedy
Ayanfeoluwa
A
Obilana
Frank
F
O'Brien
Patrick
P
O'Kelly
Anathony
A
Dorman
Mark
M
Denton
Colm
C
Magee
Peter
P
Conlon
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000453:epidemiology* / Q000473:pathology; D005922:Glomerulonephritis, IGA / Q000453:epidemiology* / Q000473:pathology; D005923:Glomerulosclerosis, Focal Segmental / Q000453:epidemiology* / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000601:surgery; D007678:Kidney Glomerulus / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult