Background: Steroid sparing immunosuppression is increasingly used in order to avoid the many well-known side effects of steroids. It has been argued that steroid use is strongly associated with a reduced risk of IgA Nephropathy (IGAN) recurrence post transplantation. In this study we investigate the effect of maintenance immunosuppression on the recurrence of IGAN.

Methods: We reviewed prospectively collected data on 133 (102 male, mean age 44.2 +/-11.5 years) kidney transplant recipients with biopsy proven IGAN as their primary diagnosis, transplanted in our center between 2002 and 2014. All the patients received a steroid sparing immunosuppressive regimen (7day course) with Alemtuzumab induction and tacrolimus monotherapy or IL2 induction with Tacrolimus and MMF. Steroids and MMF were only introduced to treat rejection. Results: 52 (39.1%) (40 male, mean age 45.2 +/-10.7 years) out of 133 patients developed biopsy proven recurrent IGAN. Mean follow up was similar between the patients with (57.5+34.7) and without recurrence (51,8+32.3) months (p=0.36). There were no significant differences in recipient age, gender, ethnicity, induction and type of transplant between the two groups, except for older donor age in the recurrent IGAN cohort.(43.5+15.1 vs 49.9+11.9 years, p=0,008) Mean time from transplantation to recurrence was 39.1 (+29.6) months). Kaplan Meier analysis showed that initiation of maintenance immunosuppression with MMF and / or Prednisolone within the 1^st year post transplant reduces the risk for IGAN recurrence. (log rank p=0.04) A multivariate Cox regression model, adjusted for donor and recipient age, recipient race and gender, type of transplant, and induction immunosuppressant medications, revealed older donor age (HR: 1.03, p=0.01) as a significant risk factor for recurrence, while MMF exposure (HR: 0.63, p<0.001) had a protective effect. During the follow up period, 10 grafts were lost. Recurrence of IGAN did not have an effect on graft survival on multivariate analysis. (p=0.29)

Conclusion: Our results indicate that maintenance immunosuppression choice can potentially affect post-transplant IgAN recurrence.

CITATION INFORMATION: Koutroutsos K, Kousios A, Leighton L, Charif R, Goodall D, Cook T, Galliford J, Taube D, Loucaidou M. The Effect of Immunosuppression Regimen on Iga Nephropathy Recurrence Post Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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