Impact of Induction Immunosuppression on the Recurrence of Primary IgA Nephropathy

Abstract

Purpose IgA nephropathy (IgAN) may recur after kidney transplantation (KT) and potentially jeopardize the survival of the graft. The object of this study was to analyze the impact of induction immunosuppression on the incidence of recurrent IgAN and identify predictive risk factors for IgAN recurrence. Methods We used data from the Samsung Medical Center to conduct a recurrence-free survival analysis of recipients of a first kidney transplant for IgAN who received a graft between 1995 and 2015. Kaplan-Meier and Cox regression analysis were used to sort the significant risk factors of recurrence. Two hundred twenty six recipients with biopsy-proven IgAN received aKT and 211 recipients were enrolled in this study. Among them, 30 cases of IgAN recurrence were observed. The recipients were categorized into four groups according to the induction immunosuppression: no induction (group 1, n=72), anti-CD25 (group 2, n=90), antithymocyte globulin (ATG, group 3, n=25), and ATG+anti-CD20 (group 4, n=24). Results Graft survival rate was lower in recipient with IgAN recurrence than those without recurrence. (p=0.001) The 5-year and 10-yearcumulative IgAN recurrence rates were 90.6% and 80.7%. Recipients received ATG (group 3) showed significantly higher 5-year recurrence free graft survival rate (100%) than recipients received no induction (group 1, 92.8%) or anti-CD25 (group 2, 85.0%). (p=0.02, <0.001, respectively). However, no significant risk factors for IgAN recurrence were identified with multivariate Cox regression analysis. Conclusion Recipients received ATG as induction immunosuppression showed low IgAN recurrence rate. However, the risk for IgAN recurrence was not associated with any specific induction immunosuppression modality. These findings should be further evaluated with well-designed prospective studies regarding the role of induction immunosuppression in reducing recurrence of IgAN.