title: Predicting Post-Transplant Recurrence of IgA Nephropathy: The Importance of Crescents.
abstract: BACKGROUND
  Most studies that have assessed the predictors of recurrent IgA nephropathy (IgAN) in the renal allograft have focused on post-transplant features. Identifying high-risk pre-transplant features of IgAN is useful for counseling patients and may help in tailoring post-transplant immunosuppression.
  
  
  METHODS
  We investigated the pre-transplant clinical and biopsy features of 62 patients with IgAN who received transplants at Columbia University Medical Center from 2001 to 2012 and compared the characteristics and outcomes of patients with IgAN recurrence to those without recurrence. The primary outcome was time to recurrent IgAN. Secondary outcomes were a composite of doubling of creatinine or allograft failure, and recurrent IgAN as a cause of allograft dysfunction.
  
  
  RESULTS
  Of the 62 patients, 14 had recurrent IgAN in the allograft. Mean time to recurrence was 2.75 years. Those with recurrent disease were younger at the time of native kidney biopsy (29 vs. 41 years, p < 0.0009). Black race and Hispanic ethnicity composed a higher proportion of the recurrent disease group. On multivariable analysis, significant predictors of recurrent IgAN included age at diagnosis (hazards ratio (HR) 0.911, 95% CI 0.85-0.98), burden of crescents on native biopsy (HR 1.21 per 10% increase in crescents, 95% CI 1.00-1.47) and allograft rejection (HR 3.59, 95% CI 1.10-11.7).
  
  
  CONCLUSIONS
  Features of native IgAN can help predict the risk of recurrent disease in the renal allograft. In particular, immunologically active disease represented by earlier age of onset and greater burden of crescents on native biopsy is more likely to recur after transplant.
authors.affiliation: Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, N.Y., USA.
authors.forename: Rupali S
authors.initials: RS
authors.lastname: Avasare
authors.forename: Paul E
authors.initials: PE
authors.lastname: Rosenstiel
authors.forename: Ziad S
authors.initials: ZS
authors.lastname: Zaky
authors.forename: Demetra S
authors.initials: DS
authors.lastname: Tsapepas
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Appel
authors.forename: Glen S
authors.initials: GS
authors.lastname: Markowitz
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Bomback
authors.forename: Pietro A
authors.initials: PA
authors.lastname: Canetta
mesh_terms: D000328:Adult; D017668:Age of Onset; D064591:Allografts / Q000276:immunology* / Q000473:pathology; D001706:Biopsy; D005260:Female; D005922:Glomerulonephritis, IGA / Q000473:pathology* / Q000601:surgery*; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007678:Kidney Glomerulus / Q000276:immunology / Q000473:pathology / Q000648:ultrastructure*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008854:Microscopy, Electron; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors