Different Recurrence Rates Between Pediatric and Adult Renal Transplantation for IgAN: Predictors of Posttransplantation Recurrence

Abstract

Purpose: IgA nephropathy (IgAN) is most common primary glomerulonephrits and a major contributor to the renal transplant. Recurrence rates after transplantation(TPL) are high but not well studied. Also, the effect of recipient age and clinical manifestations on recurrence has not been evaluated thoroughly. Purpose of this study is to investigate IgAN recurrence rate after TPL in children and adults and to identify recurrence-associated factors by age. Methods: All consecutive kidneys transplants performed at single center between January 1989 and December 2005 were included in this analysis. Subjects were divided into two group by recipient age (less than or greater than 20 years at the time of transplant). And then, each group was divided into two subgroups based on recurrence. Each groups were analyzed distinctively by the steps of clinical manifestations (fig 1)[Fig 1]Results: A total of 56 patients were enrolled in the study. The recurrence rate was higher in < 20yr with 53.8% than > 20 yr with 23.3% (P = 0.046) (fig 2). However, there was no statistical difference in graft loss between groups. In a subgroup analysis (age), there was no factor noted statistically related to the recurrence in < 20yr. However, progressive symptoms to renal replacement therapy (PS to RRT) was significantly shorter in the recurrent >20yr than in no-recurrent >20yr. The univariate relative risk of recurrent IgAN after transplant for >20yr recipient whose the time of PS to RRT was less than 24 months was 9.8 (95% CI: 1.04-92.70; p = 0.046)[Fig 2]Conclusion: For >20 yr, the recurrent group, in comparison the no-recurrent group, displayed more rapid deterioration from PS to RRT. These results carefully suggest that there are tendencies to recur in adults with rapid deterioration to ESRD. Therefore, renal transplantation may not be needed to hasten in adults with rapid deterioration. Figure 1: Definitions of clinical progression. IS = initial signs; PS = progressive symptoms; RRT = renal replacement therapy Figure 2: Schematic diagram of the study design, groups according to recurrence and age, and outcomes.