title: The Dutch Transplantation in Vasculitis (DUTRAVAS) Study: Outcome of Renal Transplantation in Antineutrophil Cytoplasmic Antibody-associated Glomerulonephritis.
abstract: BACKGROUND
  Data on the outcome of renal transplantation in antineutrophil cytoplasmic antibody-associated glomerulonephritis (AAGN) patients are still limited. In particular, how disease recurrence in the renal allograft defines graft outcome is largely unknown. Therefore, we conducted a multicenter observational clinical and histopathological study to establish recurrence rate of AAGN in the allograft and the impact of recurrence on allograft survival.
  
  
  METHODS
  Using the nationwide Dutch Pathology Registry (PALGA), we retrospectively collected clinical and histopathological data of consecutive AAGN patients who had developed end-stage renal failure and received a kidney allograft in 1 of 6 Dutch university hospitals between 1984 and 2011. Transplant biopsies were scored using the Banff '09 classification. Renal disease recurrence was scored using the histopathological classification of AAGN.
  
  
  RESULTS
  The posttransplantation recurrence rate of AAGN was 2.8% per patient year, accumulating to recurrence in a total of 11 of 110 AAGN patients within the first 5 years after transplantation. Four of these 11 patients lost their graft, with 1-year and 5-year graft survival rates of 94.5% and 82.8%, respectively. By multivariate analysis, AAGN recurrence was independently associated with subsequent graft loss.
  
  
  CONCLUSIONS
  In this study in 110 Dutch patients, the recurrence rate of AAGN within 5 years after kidney transplantation appeared slightly higher than in previous reports. Moreover, recurrence of AAGN contributed independently to kidney allograft loss, emphasizing the importance of clinical vigilance, because early treatment might be critical to rescuing the allograft.
authors.affiliation: 1 Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands. 2 Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands. 3 Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands. 4 Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands. 5 Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands. 6 Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. 7 Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands. 8 Department of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands. 9 Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands. 10 Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands. 11 Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands. 12 Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands. 13 School of Immunity and Infection, Center for Translational Inflammation Research, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom 14 Trinity Health Kidney Center, Tallaght Hospital Campus, School of Medicine, Trinity College Dublin, Dublin, Ireland. 15 Department of Nephrology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Arda
authors.initials: A
authors.lastname: Göçeroğlu
authors.forename: Chinar
authors.initials: C
authors.lastname: Rahmattulla
authors.forename: Annelies E
authors.initials: AE
authors.lastname: Berden
authors.forename: Marlies E J
authors.initials: ME
authors.lastname: Reinders
authors.forename: Ron
authors.initials: R
authors.lastname: Wolterbeek
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Steenbergen
authors.forename: Luuk B
authors.initials: LB
authors.lastname: Hilbrands
authors.forename: Iris
authors.initials: I
authors.lastname: Noorlander
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Berger
authors.forename: Carine J
authors.initials: CJ
authors.lastname: Peutz-Kootstra
authors.forename: Maarten H L
authors.initials: MH
authors.lastname: Christiaans
authors.forename: Marcory C R F
authors.initials: MC
authors.lastname: van Dijk
authors.forename: Anoek A E
authors.initials: AA
authors.lastname: de Joode
authors.forename: Roel
authors.initials: R
authors.lastname: Goldschmeding
authors.forename: Arjan D
authors.initials: AD
authors.lastname: van Zuilen
authors.forename: Lorraine
authors.initials: L
authors.lastname: Harper
authors.forename: Mark A
authors.initials: MA
authors.lastname: Little
authors.forename: E Christiaan
authors.initials: EC
authors.lastname: Hagen
authors.forename: Jan A
authors.initials: JA
authors.lastname: Bruijn
authors.forename: Ingeborg M
authors.initials: IM
authors.lastname: Bajema
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D001706:Biopsy; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D006085:Graft Survival; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome