Background: There has been an increase in the use of steroid-avoidance regimens. However, there is some evidence to suggest that steroid avoidance may be associated with a higher rate of recurrent IgA nephropathy (IgAN).

Methods: Using UNOS/OPTN data, adult patients with first kidney transplant for IgAN between 2000 and 2014 were analyzed. For the primary outcome, we used a competing risk analysis to compare the cumulative incidence of graft loss due to IgAN recurrence between steroid avoidance and steroid maintenance groups. The secondary outcomes were patient survival and death-censored graft survival (DCGS).

Results: A total of 9771 recipients were included (2876 in steroid-free and 6895 in steroid group). 191 (14.48%) of 1319 graft losses were due to IgAN recurrence. In multivariate analysis adjusted for recipient and donor age, sex and race, donor type, dialysis duration and transplant eras, steroid use was associated with a decreased risk of graft loss due to IgAN recurrence (subhazard ratio 0.665, 95% CI 0.481-0.919; p=0.014). However, patient survival and DCGS were not different between the two groups. Steroid therapy did not have any effect on graft loss due to BK virus nephropathy. Apart from steroids, we found no association between the use of other induction or maintenance immunosuppressive medications and the risk of graft loss due to IgAN recurrence.

Conclusion: In the U.S., steroid avoidance in transplant for ESRD due to IgAN is associated with a higher risk of graft loss due to disease recurrence. Future prospective studies are warranted to further address which patients with IgAN would benefit from steroid continuation.10-year unadjusted cumulative incidence of graft loss due to IgA recurrence stratified by steroid use upon discharge.

CITATION INFORMATION: Leeaphorn N, Garg N, Khankin E, Cardarelli F, Pavlakis M. Recurrence of IgA Nephropathy After Kidney Transplantation in Maintenance Steroids versus Steroid Avoidance Regimens: A UNOS/OPTN Analysis. Am J Transplant. 2017;17 (suppl 3).

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