BACKGROUND: The recurrence of IgA nephropathy (IgAN) in the allograft is common. Factors related to IgA recurrence are unclear. The aims of this study were to determine the incidence of IgAN recurrence as assessed by protocol biopsies and to identify predictive factors for recurrence. METHODS: We identified 65 protocol biopsies taken before the second year post-transplantation in patients with IgAN as primary renal disease. Diagnosis of recurrence of IgA was based on the detection of at least 1+ mesangial deposits of IgA. Pathological findings and clinical characteristics were retrospectively compared between recurrent and non-recurrent cases. RESULTS: IgAN recurrence rate was 32%. Mesangial C3 was detected in 83% of recurrent cases versus 17% in non-recurrent patients (P < 0.001). Normal urinalysis was observed in 52%. Non-recurrent patients had arteriolar hyalinosis in 31% of the cases versus none in IgAN recurrence (P = 0.006). Seventy-nine per cent of cyclosporine users were free of recurrence, whereas 45% of the patients without cyclosporine experienced recurrence (P = 0.03). The odds ratio (OR) for IgAN recurrence in patients using cyclosporine was 0.3 (confidence interval 0.1-0.9). Zero HLA-DR mismatch was associated with non-recurrence (P < 0.01). The OR for IgA recurrence was 6.7 if any degree of DR mismatch was present. IgAN recurrent patients had better glomerular filtration rate, but after censoring delayed graft function, the differences disappeared. Graft loss due to IgA recurrence was only 3%. CONCLUSIONS: IgAN recurrence rate was 32%. The histological diagnosis was not accompanied by abnormalities in the urinalysis in one-half of the patients. Full DR match and cyclosporine were associated with non-recurrence.
BACKGROUND: The recurrence of IgA nephropathy (IgAN) in the allograft is common. Factors related to IgA recurrence are unclear. The aims of this study were to determine the incidence of IgAN recurrence as assessed by protocol biopsies and to identify predictive factors for recurrence. METHODS: We identified 65 protocol biopsies taken before the second year post-transplantation in patients with IgAN as primary renal disease. Diagnosis of recurrence of IgA was based on the detection of at least 1+ mesangial deposits of IgA. Pathological findings and clinical characteristics were retrospectively compared between recurrent and non-recurrent cases. RESULTS:IgAN recurrence rate was 32%. Mesangial C3 was detected in 83% of recurrent cases versus 17% in non-recurrent patients (P < 0.001). Normal urinalysis was observed in 52%. Non-recurrent patients had arteriolar hyalinosis in 31% of the cases versus none in IgAN recurrence (P = 0.006). Seventy-nine per cent of cyclosporine users were free of recurrence, whereas 45% of the patients without cyclosporine experienced recurrence (P = 0.03). The odds ratio (OR) for IgAN recurrence in patients using cyclosporine was 0.3 (confidence interval 0.1-0.9). Zero HLA-DR mismatch was associated with non-recurrence (P < 0.01). The OR for IgA recurrence was 6.7 if any degree of DR mismatch was present. IgAN recurrent patients had better glomerular filtration rate, but after censoring delayed graft function, the differences disappeared. Graft loss due to IgA recurrence was only 3%. CONCLUSIONS:IgAN recurrence rate was 32%. The histological diagnosis was not accompanied by abnormalities in the urinalysis in one-half of the patients. Full DR match and cyclosporine were associated with non-recurrence.
Authors: Laureline Berthelot; Thomas Robert; Vincent Vuiblet; Thierry Tabary; Antoine Braconnier; Moustapha Dramé; Olivier Toupance; Philippe Rieu; Renato C Monteiro; Fatouma Touré Journal: Kidney Int Date: 2015-06-10 Impact factor: 10.612
Authors: Maria Messina; Maria Cristina di Vico; Claudia Ariaudo; Gianna Mazzucco; Fabrizio Fop; Giuseppe Paolo Segoloni; Luigi Biancone Journal: J Nephrol Date: 2016-05-23 Impact factor: 3.902
Authors: Gabriella Guzzo; Salima Sadallah; Heidi Fodstad; Jean-Pierre Venetz; Samuel Rotman; Daniel Teta; Thierry Gauthier; Giuseppe Pantaleo; Andrea Superti-Furga; Manuel Pascual Journal: Front Genet Date: 2021-05-20 Impact factor: 4.599
Authors: Audrey Uffing; Maria José Pérez-Saéz; Thomas Jouve; Mathilde Bugnazet; Paolo Malvezzi; Saif A Muhsin; Marie-Camille Lafargue; Roman Reindl-Schwaighofer; Alina Morlock; Rainer Oberbauer; Anna Buxeda; Carla Burballa; Julio Pascual; Seraina von Moos; Harald Seeger; Gaetano La Manna; Giorgia Comai; Claudia Bini; Luis Sanchez Russo; Samira Farouk; Pitchaphon Nissaisorakarn; Het Patel; Nikhil Agrawal; Gianna Mastroianni-Kirsztajn; Juliana Mansur; Hélio Tedesco-Silva; Carlucci Gualberto Ventura; Fabiana Agena; Elias David-Neto; Enver Akalin; Omar Alani; Marilda Mazzali; Roberto Ceratti Manfro; Andrea Carla Bauer; Aileen X Wang; Xingxing S Cheng; Jesse D Schold; Stefan P Berger; Paolo Cravedi; Leonardo V Riella Journal: Clin J Am Soc Nephrol Date: 2021-08 Impact factor: 10.614