Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: IgA nephropathy (IgAN) is the most frequent biopsy-proven primary glomerular disease. Recurrent IgA after transplantation often leads to allograft loss. A lower risk of recurrent glomerulonephritis, including IgAN, has been associated with corticosteroid maintenance but notably, patient survival and death censored graft-survival do not differ with steroid use or not. Our center utilizes a rapid corticosteroid withdrawal (CSW) protocol (d. 0-2 only), which is substantially lower than most transplant centers. We wanted to evaluate clinical outcomes of our IgA recipients in our CSW program and compare the results with publicly available UNOS data.
*Methods: Subjects included all living and deceased donor renal transplant recipients at our center or from the UNOS transplant database from January 1, 1999 to Dec 31, 2018 Patients <18 years old, liver-kidney transplantation, primary non-function, individuals with re-transplants, or that were lost to follow-up were excluded. A total of 61 patients with IgAN native kidney disease from our center were used for the analysis. The same exclusion criteria were applied to the UNOS data and only patients on FK and MMF maintenance were used for a comparable cohort. A total of 1,991 patients with IgAN met criteria and were indicated as steroid free (CSW) at discharge and did not have corticosteroid use indicated at any follow-up. Statistical comparisons of proportions employed a 2-sample Chi-Squared test for equality of proportions with Yate’s continuity correction.
*Results: IgAN all-cause graft failures was not significantly different at our center (6.6%) when compared to the UNOS data (5.1%) (p>0.80). Comparison of all-cause mortality between our center and the UNOS data, IgAN mortality rates also did not significantly differ (8.2% vs. 3.7%, p>0.10).
*Conclusions: These preliminary findings indicate that patients at our center who are early corticosteroid withdrawal following transplant with IgAN as primary diagnosis have comparable outcomes in terms of all-cause graft failure and mortality with patients listed in UNOS. A limitation of the present study is that given the low incidence rates, we would require a larger cohort of patients to study at our center in order to make definitive statistical conclusions. However, these preliminary findings assure us that IgAN outcomes are not a cause of concern in our early corticosteroid withdrawal center.
To cite this abstract in AMA style:Kurian S, Spierling S, Barrick B, Rice J, Case J, Marsh C. IgA Nephropathy Outcomes after Kidney Transplantation in an Early Corticosteroid Withdrawal Center [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/iga-nephropathy-outcomes-after-kidney-transplantation-in-an-early-corticosteroid-withdrawal-center/. Accessed October 25, 2020.
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