The objective of this study was to determine the rate of recurrence of IgA nephropathy in our program aided by protocol biopsies and protocol driven clinical monitoring.

We conducted a retrospective review of solitary kidney transplant recipients at our program from 1999-2012. Patients with native kidney biopsy proven IgA nephropathy were reviewed. Protocol biopsies were performed independent of function at the time of implantation, 4 months and, 1, 2 and 5 years post-transplant independent of allograft function. Patients transplanted after September 2012 were excluded to allow for a minimum of 5 years of follow up for all patients. Histological recurrence was defined as IgA deposition with mesangial proliferation. Clinical recurrence was defined as histological recurrence with proteinuria>300 mg on a 24-hour urine collection. Non-IgA patients were controls.

During the study period 2737 patients received a kidney transplant. 137 (5.01%) had IgA nephropathy. IgA patients were younger 41.7± 13.0 vs. 49.3 ± 15.6 (p<0.001) years, male 75.2 vs. 56.6% (p<0.001), and more likely to have received a living donor 89.1 vs. 74.2 % (p<0.001). Follow up was 94.2 ± 52.3 months.

75 (54.7%) of patients had histological recurrence and of those 89 had 24-hour urine collections and biopsy. Of those 45 (50.6%) had a clinical recurrence. Of those 12/44 (27%) lost their graft from disease recurrence 71.9 ± 43 (28-152) months from transplant. Patient with clinical recurrence were not at greater risk of graft loss HR (95 CI, p) 1.26 (0.7-2.2, 0.4), 1.15 (0.6-2.0, 0.6) adjusted for age and donor type compared to non-IgA patients. Clinical recurrence however increased the risk of graft loss HR (95 CI, p 6.5 (1.45-29.5, 0.01).

Although IgA nephropathy appears to be benign post-transplant, it does provide an opportunity for targeted therapy to prolong graft survival in a frequently younger recipient population.

CITATION INFORMATION: Merzkani M., Lepori N., El Ters M., Cosio F., Amer H. IgA Recurrence in a Single Center with a Protocol Biopsy Program Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress