title: The risk of recurrent IgA nephropathy in a steroid-free protocol and other modifying immunosuppression.
abstract: Recurrent glomerulonephritis is an important cause of kidney allograft failure. The effect of immunosuppression on recurrent IgA nephropathy (IgAN) is unclear. We analyzed the impact of steroids and other immunosuppression on the risk of recurrent IgAN post-kidney transplantation. Between June 1989 and November 2008, 3311 kidney transplants were performed at our center. IgAN was the primary disease in 124 patients; of these, 75 (60.5%) patients received steroid-based immunosuppression (15 undergoing late steroid withdrawal), and 49 (39.5%) were maintained on steroid-free immunosuppression. Recurrent IgAN was diagnosed in 27 of 124 (22%) patients in clinically indicated kidney allograft biopsies over a median follow-up of 6.86 ± 5.4 yr. On cox proportional hazards model multivariate analysis, the hazard risk (HR) of IgAN recurrence was significantly higher in patients managed with steroid-free (HR 8.59: 3.03, 24.38, p < 0.001) and sirolimus-based (HR = 3.00:1.16, 7.75, p = 0.024) immunosuppression without antilymphocyte globulin induction (HR = 4.5: 1.77, 11.73, p = 0.002). Mycophenolate use was associated with a lower risk (HR = 0.42: 0.19, 0.95, p = 0.036), whereas cyclosporine did not have a significant impact on the risk of IgAN recurrence (p = 0.61). These results warrant future prospective studies regarding the role of steroids and other immunosuppression drugs in reducing recurrence of IgAN and other glomerulonephritis post-transplant.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, The Ohio State University College of Medicine and Public Health, Columbus, OH, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Von Visger
authors.forename: Y
authors.initials: Y
authors.lastname: Gunay
authors.forename: K A
authors.initials: KA
authors.lastname: Andreoni
authors.forename: U Y
authors.initials: UY
authors.lastname: Bhatt
authors.forename: U S
authors.initials: US
authors.lastname: Nori
authors.forename: T E
authors.initials: TE
authors.lastname: Pesavento
authors.forename: E A
authors.initials: EA
authors.lastname: Elkhammas
authors.forename: H A
authors.initials: HA
authors.lastname: Winters
authors.forename: T
authors.initials: T
authors.lastname: Nadasdy
authors.forename: N
authors.initials: N
authors.lastname: Singh
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005922:Glomerulonephritis, IGA / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents
keywords: glomerulonephritis; steroids; transplant