title: Long-term Kidney Transplant Outcomes in Primary Glomerulonephritis: Analysis From the ERA-EDTA Registry.
abstract: BACKGROUND
  We evaluated the 15-year kidney allograft survival in patients with primary glomerulonephritis and determined if the risk of graft loss varied with donor source within each glomerulonephritis group.
  
  
  METHODS
  Using data from the European Renal Association-European Dialysis and Transplant Association Registry, Kaplan-Meier, competing risk, and Cox regression analyses were performed on adult, first kidney transplant recipients during 1991 to 2010 (n = 14 383). Follow-up was set to December 31, 2011. Adjustments for pretransplant dialysis duration, sex, country, and transplant era were made. "Death-adjusted graft survival" was assessed in patients with glomerulonephritis and compared with those with autosomal dominant polycystic kidney disease (ADPKD), in which the native kidney disease cannot recur. Additionally, death-adjusted graft survival was compared between living and deceased donor transplants within each glomerulonephritis group.
  
  
  RESULTS
  All glomerulonephritides had a 15-year death-adjusted graft survival probability above 55%. The 15-year risk of death-adjusted graft failure compared to ADPKD ranged from 1.17 (95% confidence interval [95% CI], 1.05-1.31) for immunoglobulin A nephropathy to 2.09 (95% CI, 1.56-2.78) for membranoproliferative glomerulonephritis type II. The expected survival benefits of living over deceased donor transplants were not present in membranoproliferative glomerulonephritis type I (adjusted hazard ratios [HRa], 1.08; 95% CI, 0.73-1.60) or type II (HRa, 0.90; 95% CI, 0.32-2.52) but present in immunoglobulin A nephropathy (HRa, 0.74; 95% CI, 0.59-0.92), membranous nephropathy (HRa, 0.47; 95% CI, 0.29-0.75), and focal segmental glomerulosclerosis (HRa, 0.69; 95% CI, 0.45-1.06).
  
  
  CONCLUSIONS
  This large European study shows favorable long-term kidney graft survival in all primary glomerulonephritides, although this remains lower than graft survival in ADPKD, and confirms that the reluctance to use living donors in some primary glomerulonephritides remains unfounded. These data will further inform prospective renal transplant recipients and donors during pretransplant counselling.
authors.affiliation: 1 Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, the Netherlands. 2 Department of Nephrology, University Hospital Virgen Macarena, Seville, Spain. 3 REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France. 4 Nephrology Service, University Hospital Marqués de Valdecilla, Santander, Spain. 5 Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland. 6 Finnish Registry for Kidney Diseases, Helsinki, Finland. 7 Department of Medicine, Roskilde Hospital, University of Copenhagen, København, Denmark. 8 Department of Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands. 9 Department of Nephrology and Dialysis and Hypertension, Dutch-Speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium. 10 Division of Nephrology, Landspitali-The National University Hospital of Iceland and Faculty of Medicine, Reykjavik, Iceland. 11 Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. 12 Department of Medicine and Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. 13 Department of Medicine and Health, Linköping University, Linköping, Sweden. 14 Department of Nephrology, Linköping University, Linköping, Sweden. 15 Scottish Renal Registry, Meridian Court, Glasgow, United Kingdom. 16 Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway. 17 UK Renal Registry, Southmead Hospital, Bristol, United Kingdom. 18 School of Social and Community Medicine, Canynge Hall, University of Bristol, Bristol, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Pippias
authors.forename: Vianda S
authors.initials: VS
authors.lastname: Stel
authors.forename: Nuria
authors.initials: N
authors.lastname: Aresté-Fosalba
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
authors.forename: Gema
authors.initials: G
authors.lastname: Fernandez-Fresnedo
authors.forename: Patrik
authors.initials: P
authors.lastname: Finne
authors.forename: James G
authors.initials: JG
authors.lastname: Heaf
authors.forename: Andries
authors.initials: A
authors.lastname: Hoitsma
authors.forename: Johan
authors.initials: J
authors.lastname: De Meester
authors.forename: Runolfur
authors.initials: R
authors.lastname: Pálsson
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.forename: Mårten
authors.initials: M
authors.lastname: Segelmark
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Traynor
authors.forename: Anna V
authors.initials: AV
authors.lastname: Reisæter
authors.forename: Fergus J
authors.initials: FJ
authors.lastname: Caskey
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
mesh_terms: D000328:Adult; D064591:Allografts; D005060:Europe; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016891:Polycystic Kidney, Autosomal Dominant / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome