Arda Göçeroğlu1, Chinar Rahmattulla, Annelies E Berden, Marlies E J Reinders, Ron Wolterbeek, Eric J Steenbergen, Luuk B Hilbrands, Iris Noorlander, Stefan P Berger, Carine J Peutz-Kootstra, Maarten H L Christiaans, Marcory C R F van Dijk, Anoek A E de Joode, Roel Goldschmeding, Arjan D van Zuilen, Lorraine Harper, Mark A Little, E Christiaan Hagen, Jan A Bruijn, Ingeborg M Bajema. 1. 1 Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands. 2 Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands. 3 Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands. 4 Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands. 5 Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands. 6 Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. 7 Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands. 8 Department of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands. 9 Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands. 10 Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands. 11 Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands. 12 Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands. 13 School of Immunity and Infection, Center for Translational Inflammation Research, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom 14 Trinity Health Kidney Center, Tallaght Hospital Campus, School of Medicine, Trinity College Dublin, Dublin, Ireland. 15 Department of Nephrology, Meander Medical Center, Amersfoort, The Netherlands.
Abstract
BACKGROUND: Data on the outcome of renal transplantation in antineutrophil cytoplasmic antibody-associated glomerulonephritis (AAGN) patients are still limited. In particular, how disease recurrence in the renal allograft defines graft outcome is largely unknown. Therefore, we conducted a multicenter observational clinical and histopathological study to establish recurrence rate of AAGN in the allograft and the impact of recurrence on allograft survival. METHODS: Using the nationwide Dutch Pathology Registry (PALGA), we retrospectively collected clinical and histopathological data of consecutive AAGN patients who had developed end-stage renal failure and received a kidney allograft in 1 of 6 Dutch university hospitals between 1984 and 2011. Transplant biopsies were scored using the Banff '09 classification. Renal disease recurrence was scored using the histopathological classification of AAGN. RESULTS: The posttransplantation recurrence rate of AAGN was 2.8% per patient year, accumulating to recurrence in a total of 11 of 110 AAGN patients within the first 5 years after transplantation. Four of these 11 patients lost their graft, with 1-year and 5-year graft survival rates of 94.5% and 82.8%, respectively. By multivariate analysis, AAGN recurrence was independently associated with subsequent graft loss. CONCLUSIONS: In this study in 110 Dutch patients, the recurrence rate of AAGN within 5 years after kidney transplantation appeared slightly higher than in previous reports. Moreover, recurrence of AAGN contributed independently to kidney allograft loss, emphasizing the importance of clinical vigilance, because early treatment might be critical to rescuing the allograft.
BACKGROUND: Data on the outcome of renal transplantation in antineutrophil cytoplasmic antibody-associated glomerulonephritis (AAGN) patients are still limited. In particular, how disease recurrence in the renal allograft defines graft outcome is largely unknown. Therefore, we conducted a multicenter observational clinical and histopathological study to establish recurrence rate of AAGN in the allograft and the impact of recurrence on allograft survival. METHODS: Using the nationwide Dutch Pathology Registry (PALGA), we retrospectively collected clinical and histopathological data of consecutive AAGN patients who had developed end-stage renal failure and received a kidney allograft in 1 of 6 Dutch university hospitals between 1984 and 2011. Transplant biopsies were scored using the Banff '09 classification. Renal disease recurrence was scored using the histopathological classification of AAGN. RESULTS: The posttransplantation recurrence rate of AAGN was 2.8% per patient year, accumulating to recurrence in a total of 11 of 110 AAGN patients within the first 5 years after transplantation. Four of these 11 patients lost their graft, with 1-year and 5-year graft survival rates of 94.5% and 82.8%, respectively. By multivariate analysis, AAGN recurrence was independently associated with subsequent graft loss. CONCLUSIONS: In this study in 110 Dutch patients, the recurrence rate of AAGN within 5 years after kidney transplantation appeared slightly higher than in previous reports. Moreover, recurrence of AAGN contributed independently to kidney allograft loss, emphasizing the importance of clinical vigilance, because early treatment might be critical to rescuing the allograft.
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