title: Long-term graft outcomes and patient survival are lower posttransplant in patients with a primary renal diagnosis of glomerulonephritis.
abstract: Glomerulonephritis (GN) is the primary diagnosis in 20% to 40% of patients receiving a renal transplant. Here we studied patient survival and graft outcomes in patients with GN transplanted in the UK. UK Renal Registry data were used to analyze patient survival and graft failure in incident transplant patients between 1997 to 2009 who had a diagnosis of primary GN, in comparison to patients transplanted with adult polycystic kidney disease (APKD) or diabetes. Multivariable regression analysis adjusted for age, sex, donor type, ethnicity, donor age, time on dialysis, human leukocyte antigen mismatch, cold ischemic time, and graft failure (for patient survival). Patients were followed up through December 2012. Of 4750 patients analyzed, 2975 had GN and 1775 APKD. Graft failure was significantly higher in membranoproliferative glomerulonephritis (MPGN) type II (hazard ratio: 3.5, confidence interval: 1.9-6.6), focal segmental glomerulosclerosis (2.4, 1.8-3.2), MPGN type I (2.3, 1.6-3.3), membranous nephropathy (2.0, 1.4-2.9), and IgA nephropathy (1.6, 1.3-2.0) compared to APKD. Survival was significantly reduced in patients with MPGN type II (4.7, 2.0-10.8), and those with lupus nephritis (1.8, 1.1-2.9). Overall graft failure for patients with GN was similar to those with diabetes. Thus, in comparison to outcomes in APKD, graft survival is significantly lower in most GNs, with variation in outcomes between different GNs. This information should assist in pretransplant counseling of patients. Further study is required to understand the reduced survival seen in lupus nephritis and MPGN type II, and to improve overall graft outcomes.
authors.affiliation: UK Renal Registry, Bristol, UK. Electronic address: Rishi.Pruthi@nhs.net.
authors.forename: Rishi
authors.initials: R
authors.lastname: Pruthi
authors.affiliation: Richard Bright Renal Unit, Southmead Hospital, Bristol, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: McClure
authors.affiliation: UK Renal Registry, Bristol, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Casula
authors.affiliation: Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Roderick
authors.affiliation: Belfast HSC Trust, Belfast, Northern Ireland.
authors.forename: Damian
authors.initials: D
authors.lastname: Fogarty
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Harber
authors.affiliation: Richard Bright Renal Unit, Southmead Hospital, Bristol, UK.
authors.forename: Rommel
authors.initials: R
authors.lastname: Ravanan
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000601:surgery; D005260:Female; D005921:Glomerulonephritis / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016891:Polycystic Kidney, Autosomal Dominant / Q000601:surgery*; D012042:Registries; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: APKD; IgA nephropathy; diabetes; glomerulonephritis; membranoproliferative glomerulonephritis (MPGN); systemic lupus erythematosus