Recurrence and graft loss after renal transplantation in adults with IgA vasculitis.
BACKGROUND
IgA vasculitis, a rare condition resulting in end-stage renal disease, is a small-vessel vasculitis that affects the kidney in 49-83 % of adults. The reported recurrence rate of IgA vasculitis in renal transplant recipients is 11.5-60 %, leading to graft loss in 0-50 % of these patients. However, limited data are available on recurrence and graft loss after renal transplantation.


METHODS
We evaluated renal transplant recipients seen from 1987 to 2015 at the Jikei University School of Medicine and the Department of Urology, Tokyo Women's Medical University. Using a 1:2 match, 21 patients with IgA vasculitis and 42 controls were selected. The mean post-transplant follow-up was 121 ± 69 months for IgA vasculitis and 147 ± 66 months for the controls.


RESULTS
The 15-year patient survival was 100 % in IgA vasculitis and 97.6 % in the controls (p = 0.22). The 5-, 10-, and 15-year graft survival rates were 95.2, 90.5, and 81 % in IgA vasculitis and 100, 90.5, and 88.1 % in the controls, respectively (p = 0.63). The recurrence rate was 28.6 % (6 of 21 cases) and half of them (3 of 6 cases) showed histological activity (ISKDC III). We treated them with methylprednisolone pulse therapy and/or tonsillectomy. None of the recurrence cases lost the allograft.


CONCLUSIONS
The long-term patient and graft survival of IgA vasculitis in renal transplantation were comparable with the previous reports. The recurrence rate was 28.6 %, but none of the recurrent cases showed allograft loss in this study. We speculate that methylprednisolone pulse therapy and/or tonsillectomy prevent the progression of recurrent IgA vasculitis.
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Mayuko
M
Kawabe
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan. izumi26@jikei.ac.jp.
Izumi
I
Yamamoto
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Yo
Y
Komatsuzaki
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Takafumi
T
Yamakawa
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Haruki
H
Katsumata
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Ai
A
Katsuma
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Aki
A
Mafune
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Yasuyuki
Y
Nakada
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Akimitsu
A
Kobayashi
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Yudo
Y
Tanno
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Ichiro
I
Ohkido
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Nobuo
N
Tsuboi
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Keitaro
K
Yokoyama
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
Shigeru
S
Horita
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Masayoshi
M
Okumi
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Hideki
H
Ishida
Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan.
Hiroyasu
H
Yamamoto
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, 105-8461, Tokyo, Japan.
Takashi
T
Yokoo
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Kazunari
K
Tanabe
D000328:Adult; D064591:Allografts; D005260:Female; D006085:Graft Survival; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D020551:Pulse Therapy, Drug; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014041:Tokyo; D014068:Tonsillectomy; D016896:Treatment Outcome; D014657:Vasculitis / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality
D007070:Immunoglobulin A; D007166:Immunosuppressive Agents; D008775:Methylprednisolone
IgA vasculitis; Kidney transplantation; Recurrence of kidney disease; Tonsillectomy
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