Abstract
IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. The disease generally runs an indolent course but may lead to ESRD in 20–30% of patients in 20 years or more after diagnosis. Patients with IgA nephropathy are ideal candidates for renal transplant because they are generally relatively young and with few comorbidities. Their graft survival is better or comparable to that of controls at 10 years, though few data are available after 10 years of follow-up. Recurrence of the original disease in the graft is a well-known complication of transplant in IgAN and is a significant cause of deterioration of graft function. Recurrent IgAN rarely manifests clinically before 3 years post transplantation. Recurrence rate is estimated to be around 30% with considerable differences among different series. Despite these factors there is no certain recurrence predictor, young age at renal transplant, rapid progression of the original disease and higher levels of circulating galactose-deficient IgA1 and IgA-IgG immune complexes are all associated with a higher rate of recurrence. Which pathogenetic mechanisms are responsible for the progression of the recurrence to graft function deterioration, and what therapy can prevent or slow down the progression of the disease in the graft, are open questions. The aim of this review is to describe the clinical outcome of renal transplantation in IgA patients with attention to the rate and the predictors of recurrence and to discuss the available therapeutic options for the management of recurrence.
Highlights
Glomerulonephritis (GN) is one of the most common diseases responsible for end stage renal disease (ESRD) in the renal registries worldwide with an incidence ranging from 10.5 to 38.2% and a prevalence from 17.6 to 53.5% [1]
This study demonstrated that normalized serum levels of galactose deficient -IgA1–specific IgG autoantibody was an independent risk factor for recurrence of the disease in the allograft
When we separately evaluated the outcome of patients with and without recurrence we found that death censored graft survival at 15 years was 51.2% in the recurrent patients and significantly better (68.3%) in the non-recurrent recipients
Summary
Glomerulonephritis (GN) is one of the most common diseases responsible for ESRD in the renal registries worldwide with an incidence ranging from 10.5 to 38.2% and a prevalence from 17.6 to 53.5% [1]. In Australia, in the period between 2010 and 2013, IgAN was responsible for 16% of all incidents ESRD [2]. Kidney transplantation is the best therapeutic option for IgAN patients. They have greater access to kidney transplant compared to patients with other kidney diseases because they are generally young and with few comorbidities. In the United States, between 2007 and 2011, the proportion of patients who received a kidney transplant within 1 year was 30.2% for IgAN compared to 2.4% for those with diabetes [3].
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