title: The long-term outcome of renal transplantation of IgA nephropathy and the impact of recurrence on graft survival.
abstract: BACKGROUND
  Few data are available on allograft survival at 15 years, the impact and the predictors of recurrence of the original disease in renal transplanted patients with IgA nephropathy (IgAN).
  
  
  METHODS
  In this retrospective study, we compared the long-term outcome of renal transplant in 190 patients with IgAN with that of 380 non-diabetic controls and evaluated the impact of recurrence of IgAN on the graft outcome.
  
  
  RESULTS
  At 15 years, the patient survival was 88.3% in IgAN patients and 82.6% in controls (P = 0.12), while the death-censored graft survival was 62.6 and 72.4%, respectively (P = 0.038). IgAN had a higher cumulative incidence of graft failures in comparison with controls even considering death as a competing risk (P = 0.025). At multivariate analysis, IgAN [relative risk (RR) = 1.468, P = 0.026], delayed graft function recovery (RR = 2.394, P = 0.000) and acute rejection (RR = 2.51, P = 0.000) were predictive of graft loss. IgAN recurred in 42 grafts (22.1%), of them, 12 were lost for recurrence and in another 6 recurrence was considered a concomitant cause of graft loss. The 15-year death censored graft survival was 68.3% in non-recurrent and 51.2% in recurrent patients (P = 0.069). Pure graft survival of non-recurrent IgAN patients was similar to that of controls (P = 0.406). At Cox analysis, the recurrence of IgAN significantly reduced from 1981 to 2010 (P = 0.0065, RR = 0.936).
  
  
  CONCLUSIONS
  IgAN emerged as an independent predictor of worse graft outcome in the long-term. Recurrence of IgAN seems to progressively reduce in transplants performed from 1981 to 2010.
authors.affiliation: Divisione di Nefrologia e Dialisi, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena IRCCS, Milano, Italy. gmoroni@policlinico.mi.it
authors.forename: Gabriella
authors.initials: G
authors.lastname: Moroni
authors.forename: Selena
authors.initials: S
authors.lastname: Longhi
authors.forename: Silvana
authors.initials: S
authors.lastname: Quaglini
authors.forename: Beniamina
authors.initials: B
authors.lastname: Gallelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Banfi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Montagnino
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Messa
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous