title: Prognostic Value of Serum Biomarkers of Autoimmunity for Recurrence of IgA Nephropathy after Kidney Transplantation.
abstract: A prognostic biomarker for IgA nephropathy (IgAN) recurrence after renal transplant is lacking. We followed 96 consecutive first renal transplant recipients with native kidney IgAN (79 men; 92 deceased donors; mean age =48.1 years) on calcineurin inhibitor-based immunosuppression over 10 years for death, allograft failure, and clinicopathologic recurrence (CPR; clinically evident and biopsy-proven). Using time-dependent Cox regression analysis and receiver operating characteristic curves, we assessed prognostic significance of levels of galactose-deficient IgA1 (Gd-IgA1; autoantigen) and Gd-IgA1-specific IgG and IgA autoantibodies in serum obtained at time of transplant or native-kidney IgAN diagnosis (30 patients only). Overall, 13 patients died, 34 kidneys failed (17 due to CPR), and 34 patients developed CPR after a mean interval of 5.8 years. Compared with healthy controls (n=30), patients had significantly elevated serum Gd-IgA1 levels at diagnosis and transplant, but levels did not associate with any outcome. Patients also had significantly elevated levels of normalized (but not total) serum Gd-IgA1-specific IgG autoantibodies at diagnosis and transplant, and the level at transplant associated with higher risk of CPR (relative risk, 2.68; 95% confidence interval, 1.26 to 5.71;P=0.01; area under the receiver operating characteristic curve, 0.62; 95% confidence interval, 0.51 to 0.74;P=0.05). Normalized Gd-IgA1-specific IgG autoantibody level remained an independent risk factor for CPR in multivariate analysis. Serum Gd-IgA1-specific IgA autoantibody level did not change between diagnosis and transplant or predict outcome. This study emphasizes post-transplant prognostic value of normalized serum IgG antiglycan autoantibody level in patients with IgAN.
authors.affiliation: Department of Nephrology, Dialysis, and Renal Transplantation, University North Hospital, Saint Etienne, France; francois.berthoux@wanadoo.fr.
authors.forename: Francois
authors.initials: F
authors.lastname: Berthoux
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Nephrology, Dialysis, and Renal Transplantation, University North Hospital, Saint Etienne, France.
authors.forename: Hesham
authors.initials: H
authors.lastname: Mohey
authors.affiliation: Department of Nephrology, Dialysis, and Renal Transplantation, University North Hospital, Saint Etienne, France.|Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP), Equipe d'Accueil 3064, Saint-Etienne, France; and Departments of.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Maillard
authors.affiliation: Department of Nephrology, Dialysis, and Renal Transplantation, University North Hospital, Saint Etienne, France.|Microbiology and.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariat
authors.affiliation: Microbiology and.
authors.forename: Jan
authors.initials: J
authors.lastname: Novak
authors.affiliation: Microbiology and.|Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Julian
mesh_terms: D001323:Autoantibodies / Q000097:blood*; D015551:Autoimmunity; D015415:Biomarkers / Q000097:blood; D005260:Female; D005922:Glomerulonephritis, IGA / Q000097:blood* / Q000276:immunology / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence
chemical_list: D001323:Autoantibodies; D015415:Biomarkers
keywords: IgA deposition; IgA nephropathy; recurrent disease; renal transplantation; transplant outcomes