Recurrent IgA Nephropathy in Kidney Transplant Recipients Receiving a Steroid Sparing Immunosuppression Protocol

K. Koutroutsos,¹ R. Charif,¹ D. Goodall,¹ C. Roufosse,² J. Galliford,¹ T. Cook,² D. Taube,¹ M. Loucaidou.¹

¹Kidney and Transplant Centre, Imperial Healthcare NHS Trust, London, United Kingdom
²Department of Histopathology, Imperial Healthcare NHS Trust, London, United Kingdom.

Meeting: 2015 American Transplant Congress

Abstract number: A53

Keywords: Glomerulonephritis, Graft failure, Kidney transplantation

Session Information

Session Name: Poster Session A: Delayed Function/Acute Injury/Outcomes/Glomerulonephritis

Session Type: Poster Session

Date: Saturday, May 2, 2015

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Exhibit Hall E

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 incidence of recurrent IgA Nephropathy (IGAN) and its effect on outcomes in kidney transplant recipients receiving a steroid sparing immunosuppressive regime.

Methods: We retrospectively reviewed the medical records of 135 (102 male, mean age 44,1 +/-11,7 years) kidney transplant recipients with biopsy proven IGAN as their primary diagnosis, transplanted in our centre between September 2002 and August 2013. All the patients received a steroid sparing immunosuppressive regime with Alemtuzumab induction and tacrolimus monotherapy or IL2 induction with Tacrolimus and MMF. Steroids and MMF were only introduced to treat rejection. The diagnosis of recurrent IGAN was based on indication and/or protocol renal biopsies.

Results: 53 (39.3%) (41 male, mean age 44,7 +/-11,3 years) out of 135 patients developed biopsy proven recurrent IGAN. Mean follow up was similar between the patients with 56,9 (+34.6) and without recurrence 51,6(+32.2) 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.(44,+15 vs 49,9+11,8 years, p=0,002) Mean time from transplantation to recurrence was 20.4 (+20.2) months). A multivariate Cox regression model, adjusted for donor and recipient sex, age, recipient race and gender, type of transplant (Live/Deceased donor, ABOi), and induction immunosuppressant medications, revealed older donor age (HR:1.03, p=0,006) and retransplantation as significant risk factors for recurrence. (HR:1.01, p=0,035) During the follow up period, 11 grafts were lost. Reccurence of IGAN did not have an effect on graft survival on multivariate analysis. (p=0.11)

Conclusion: Recurrent IGAN in patients receiving a steroid sparing immunosuppression protocol appears to have an incidence within the range reported in the literature. In this medium term data series, recurrent IGAN does not appear to affect graft outcomes.

To cite this abstract in AMA style:

Koutroutsos K, Charif R, Goodall D, Roufosse C, Galliford J, Cook T, Taube D, Loucaidou M. Recurrent IgA Nephropathy in Kidney Transplant Recipients Receiving a Steroid Sparing Immunosuppression Protocol [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/recurrent-iga-nephropathy-in-kidney-transplant-recipients-receiving-a-steroid-sparing-immunosuppression-protocol/. Accessed November 21, 2024.

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