The long-term outcome of renal transplantation of IgA nephropathy and the impact of recurrence on graft survival

Gabriella Moroni, Selena Longhi, Silvana Quaglini, Beniamina Gallelli, Giovanni Banfi, Giuseppe Montagnino, Piergiorgio Messa

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Abstract

Background Few data are available on allograft survival at 15 years, the impact and the predictors of recurrence of the original disease in renal transplanted patients with IgA nephropathy (IgAN). Methods In this retrospective study, we compared the long-term outcome of renal transplant in 190 patients with IgAN with that of 380 non-diabetic controls and evaluated the impact of recurrence of IgAN on the graft outcome.ResultsAt 15 years, the patient survival was 88.3% in IgAN patients and 82.6% in controls (P = 0.12), while the death-censored graft survival was 62.6 and 72.4%, respectively (P = 0.038). IgAN had a higher cumulative incidence of graft failures in comparison with controls even considering death as a competing risk (P = 0.025). At multivariate analysis, IgAN [relative risk (RR) = 1.468, P = 0.026], delayed graft function recovery (RR = 2.394, P = 0.000) and acute rejection (RR = 2.51, P = 0.000) were predictive of graft loss. IgAN recurred in 42 grafts (22.1%), of them, 12 were lost for recurrence and in another 6 recurrence was considered a concomitant cause of graft loss. The 15-year death censored graft survival was 68.3% in non-recurrent and 51.2% in recurrent patients (P = 0.069). Pure graft survival of non-recurrent IgAN patients was similar to that of controls (P = 0.406). At Cox analysis, the recurrence of IgAN significantly reduced from 1981 to 2010 (P = 0.0065, RR = 0.936). Conclusions IgAN emerged as an independent predictor of worse graft outcome in the long-term. Recurrence of IgAN seems to progressively reduce in transplants performed from 1981 to 2010.

Original languageEnglish
Pages (from-to)1305-1314
Number of pages10
JournalNephrology Dialysis Transplantation
Volume28
Issue number5
DOIs
Publication statusPublished - May 2013

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Keywords

  • IgA nephropathy
  • recurrent glomerulonephritis
  • renal transplantation

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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