Background A recent multicenter study demonstrates predictive value of crescents in native IgA nephropathy (IgAN), however it remains unclear whether allograft crescent is associated with worse graft prognosis in kidney transplant recipients.

Methods We reviewed 376 IgAN patients who received kidney transplantation from 1979-2016 in a university hospital in Korea. Allograft biopsies were performed when patients had a significant proteinuria, hematuria, or a progressive deterioration of renal function. Clinical and pathologic characteristics at the time of biopsy were collected in recurrent IgAN cases. The degree of the crescent formation was classified into prominent (> 10%), mild (0-10%), and none (0%). The renal outcome was death-censored graft failure (DCGF). The association of the crescent formation and the renal prognosis was evaluated by multivariate Cox proportional hazard method.

Results During the follow-up duration of 7.0 (3.7-14.3) years, 122 (32.3%) patients were diagnosed as recurrent IgAN. In the study cohort, IgAN recurrence itself was a strong risk factor for DCGF (adjusted HR 2.626, 95% CI 1.569-4.394, P<0.001). Crescent was identified in 20 patients with recurrent IgAN, in those with relatively old graft age and decreased renal function at the time of IgAN recurrence. Interestingly, among 5 patients with prominent (>10%) crescents, 4 (80%) patients progressed to DCGF. Their median duration to DCGF was 1.6 years, which was shorter than the duration (1.9 years) of other recurrent IgAN patients who progressed to DCGF. Moreover, the presence of prominent (>10%) crescent in transplanted kidney was a strong risk factor for DCGF in patients with IgAN recurrence in multivariate analysis (adjusted HR 5.248, 95% CI 1.629-16.909, P=0.005).

Conclusion In spite of its rarity, prominent allograft crescent (>10%) was demonstrated to attribute to rapid renal deterioration in recurrent IgAN patients. Treatment strategies for those patients should be investigated.

CITATION INFORMATION: Park S, Cho H, Yu M.-Y, Kim Y, Moon K, Kim Y, Lee H. Allograft Crescent Predicts Graft Failure in Recurrent IgA Nephropathy Patients. Am J Transplant. 2017;17 (suppl 3).

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