Post-transplant glomerulopathy impact in renal graft survival
Abstract
Introduction: Primary glomerulopathy is cause of renal chronic disease in renal transplant recipients (30%-50%), being an important determinant in graft survival. Recent studies reveal that recurrence was the third most frequent cause of graft lost after 10 years post-transplant monitoring process. Objective: To analyze posttransplant glomerulopathy impact as a graft lost predictor. Methods: Between January 1990 and April 2013, 849 renal biopsies were carried out on 375 transplanted patients, 50 glomerulopathy cases were diagnosed. This population was compared with an historical renal transplant recipients group between 2000 to 2011, without glomerulopathy. Renal graft survival was analyzed in both populations. Results: 50 post-transplant glomerulopathies were diagnosed in 47 patients. We did not find statistically significant differences between this group and the historical one concerning recipient age, donor sex, donor type, miss match number, organ ischaemia time, acute rejection rate, delayed graft function, and neither in the recipient mortality. We did find significant differences in male sex, 88% vs 55% (p≤ 0.05). Renal graft lost rate was significantly more frequent among patients presenting glomerular disease 38 vs 8 % (p ≤ 0.01). Conclusion: In our population, post transplant glomerulopathy was associated to graft survival reduction and a higher membranoproliferative glomerulopathy lost rate was observed.
References
Briganti EM, Russ GR, McNeil JJ, Atkins RC, Chadban SJ. Risk of renal allograft loss from recurrent glomerulonephritis. N Engl J Med. 2002;347(2):103-9.
Disney APS, ed. The 22nd Annual Report. Australia and New Zeland Dialysis and Transplant Registry 1999 [Internet]. Disponible en: http://www.anzdata.org.au/anzdata/AnzdataReport/22ndReport/files/99%20Report.pdf (citado: 20/05/2002).
Briggs JD, Jones E. Recurrence of glomerulonephritis following renal transplantation. Scientific Advisory Board of the ERA-EDTA Registry. European Renal Association-European Dialysis and Transplant Association. Nephrol Dial Transplant. 1999;14(3):564-5.
Hariharan S, Adams MB, Brennan DC, Davis CL, First MR, Johnson CP, et al. Recurrent and de novo glomerular disease after renal transplantation: a report from Renal Allograft Disease Registry (RADR). Transplantation. 1999;68(5):635-41.
Merion RM, White DJ, Thiru S, Evans DB, Calne RY. Cyclosporine: five years' experience in cadaveric renal transplantation. N Engl J Med. 1984;310(3):148-54.
Neumayer HH, Kienbaum M, Graf S, Schreiber M, Mann JF, Luft FC. Prevalence and long-term outcome of glomerulonephritis in renal allografts. Am J Kidney Dis. 1993;22(2):320-5.
Kotanko P, Pusey CD, Levy JB. Recurrent glomerulonephritis following renal transplantation. Transplantation. 1997;63(8):1045-52.
Lorenz EC, Sethi S, Leung N, Dispenzieri A, Fervenza FC, Cosio FG. Recurrent membranoproliferative glomerulonephritis after kidney transplantation. Kidney Int. 2010;77(8):721-8.
Morales JM, Marcén R, Andres A, Domínguez-Gil B, Campistol JM, Gallego R, et al. Renal transplantation in patients with hepatitis C virus antibody. A long national experience. NDT Plus. 2010;3(Suppl. 2):ii41-ii46.
Yap HK, Cheung W, Murugasu B, Sim SK, Seah CC, Jordan SC. Th1 and Th2 cytokine mRNA profiles in childhood nephrotic syndrome: evidence for increased IL-13 mRNA expression in relapse. J Am Soc Nephrol. 1999;10(3):529-37.
Bruneau S, Le Berre L, Hervé C, Valanciuté A, Kamal M, Naulet J, et al. Potential role of soluble ST2 protein in idiopathic nephrotic syndrome recurrence following kidney transplantation. Am J Kidney Dis. 2009;54(3):522-32.
Pescovitz MD, Book BK, Sidner RA. Resolution of recurrent focal segmental glomerulosclerosis proteinuria after rituximab treatment. N Engl J Med. 2006;354(18):1961-3.
Canaud G, Martinez F, Noël LH, Mamzer MF, Niaudet P, Legendre C. Therapeutic approach to focal and segmental glomerulosclerosis recurrence in kidney transplant recipients. Transplant Rev (Orlando). 2010;24(3):121-8.
Dantal J, Godfrin Y, Koll R, Perretto S, Naulet J, Bouhours JF, et al. Antihuman immunoglobulin affinity immunoadsorption strongly decreases proteinuria in patients with relapsing nephrotic syndrome. J Am Soc Nephrol. 1998;9(9):1709-15.
Zimmerman SW. Increased urinary protein excretion in the rat produced by serum from a patient with recurrent focal glomerular sclerosis after renal transplantation. Clin Nephrol. 1984;22(1):32-8.
Kim BK, Hong HK, Kim JH, Lee HS. Differential expression of nephrin in acquired human proteinuric diseases. Am J Kidney Dis. 2002;40(5):964-73.
Noris M, Remuzzi G. Atypical hemolytic-uremic syndrome. N Engl J Med. 2009;361(17):1676-87.
Legendre CM, Licht C, Muus P, Greenbaum LA, Babu S, Bedrosian C, et al. Terminal Complement Inhibitor Eculizumab in Atypical Hemolytic–Uremic Syndrome. N Engl J Med. 2013;368(23):2169-81.
Ruggenenti P, Noris M, Remuzzi G. Thrombotic microangiopathy, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Kidney Int. 2001 ;60(3):831-46.
Ponticelli C, Traversi L, Feliciani A, Cesana BM, Banfi G, Tarantino A. Kidney transplantation in patients with IgA mesangial glomerulonephritis. Kidney Int. 2001;60(5):1948-54.
Berger J, Noël LH, Nabarra B. Recurrence of mesangial IgA nephropathy after renal transplantation. Contrib Nephrol. 1984;40:195-7.
Odum J, Peh CA, Clarkson AR, Bannister KM, Seymour AE, Gillis D, et al. Recurrent mesangial IgA nephritis following renal transplantation. Nephrol Dial Transplant. 1994;9(3):309-12.
Choy BY, Chan TM, Lo SK, Lo WK, Lai KN. Renal transplantation in patients with primary immunoglobulin A nephropathy. Nephrol Dial Transplant. 2003;18(11):2399-404.
Contreras G, Mattiazzi A, Guerra G, Ortega LM, Tozman EC, Li H, et al. Recurrence of lupus nephritis after kidney transplantation. J Am Soc Nephrol. 2010;21(7):1200-7.
