Evaluation of tonsillectomy before kidney transplantation in patients with IgA nephropathy.
The effectiveness of a tonsillectomy before kidney transplantation (KTx) in suppressing the recurrence of IgA nephropathy (IgAN) has never been studied. The aim of this study was to analyze the effectiveness of a preoperative tonsillectomy for preventing IgAN recurrence and to identify predictive risk factors for IgAN recurrence. Of the 462 recipients who underwent a KTx between 2006 and 2011, a total of 78 patients had biopsy-proven IgAN as their primary disease. Among these 78 patients, 28 patients (group 1) underwent a tonsillectomy and 50 patients (group 2) did not undergo a tonsillectomy before KTx. The time to recurrence was 15.5±8.7months, in group 1 and 20.2±18.6months in group 2. No significant difference was observed between the two groups (P=0.63). Using a multivariate Cox regression analysis, ABO incompatible KTx and acute rejection were associated with a lower incidence of recurrence (P=0.02 and 0.002 respectively). These results suggested that a preoperative tonsillectomy might not affect the recurrence of IgAN during a short-term follow-up period, whereas preoperative desensitization and the use of a higher steroid dose were effective for suppressing the recurrence of IgAN.
Department of Urology, Kidney Center, Tokyo Women's Medical University, Japan. Electronic address: s42000068w@gmail.com.
Yasuyuki
Y
Sato
Department of Urology, Kidney Center, Tokyo Women's Medical University, Japan.
Hideki
H
Ishida
Department of Urology, Kidney Center, Tokyo Women's Medical University, Japan.
Tomokazu
T
Shimizu
Department of Urology, Kidney Center, Tokyo Women's Medical University, Japan.
Kazunari
K
Tanabe
D000017:ABO Blood-Group System / Q000276:immunology; D000208:Acute Disease; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D006084:Graft Rejection / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use; D014068:Tonsillectomy
D000017:ABO Blood-Group System; D013256:Steroids
ABO-i; ABO-incompatible transplantation; AR; DSA; FK506, tac; IgA nephropathy; IgA nephropathy recurrence; IgAN; KTx; Kidney transplantation; MMF; MP; Tonsillectomy; acute rejection; donor-specific antibody; eGFR; estimated glomerular filtration rate; kidney transplantation; methylprednisolone; mycophenolate mofetil; rit; rituximab; s-Cr; serum creatinine level; tacrolimus