In the largest single center study of its kind, we assessed patient and allograft outcomes in 598 patients with the four most common causes of biopsy proven glomerulonephritis (IgAN=226, FSGS=239, MGN=76 and MPGN=57) transplanted between 1993 and 2009. Patients were followed up to 16 years (mean follow-up 7.2+/-4.7 years). There were 78 (13%) cases of biopsy confirmed recurrence. Primary IgAN had the lowest recurrence (p<0.05) and best graft and patient survival rates (p<0.01). Univariate and multivariable regression analyses demonstrated that younger age and shorter duration of disease prior to transplant were associated with higher recurrence rates in general (p<0.0001). However, the risk of graft loss was 1.8 to 2.3 times higher in patients with primary FSGS, MGN and MPGN compared to IgAN (p<0.004). Incidence rate for graft failure for IgAN was 3.27% [95% CI: 2.47, 4.31] per year (50 events), significantly lower than others (all p<0.003), which did not significantly differ from each other. The type of primary GN did not significantly affect patient death. Importantly, the risk of rejection was 59% greater in patients with MGN compared to other GNs (HR 1.59, 95% CI 1.13 to 2.24, p=0.007). At 3 years, 50% of patients with MGN had an episode of acute rejection (p=0.04). In conclusion, primary IgAN has the best outcome after transplantation compared to other common causes of GN. Further studies are needed to examine the association of primary MGN with acute rejection and to determine the benefits of protocol biopsies and early management of recurrence.

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