Long-term outcomes of kidney transplant recipients with end-stage kidney disease attributed to presumed/advanced glomerulonephritis or unknown cause

Wai H Lim,Germaine Wong,Grant Luxton,Peter Hughes,Stephen P Mcdonald,Helen L Pilmore,Tom Barbour,Aron Chakera,Steven J Chadban,Nicole M Isbel

doi:10.1038/s41598-018-27151-4

Abstract

People with biopsy-proven glomerulonephritis (GN) as their cause of end-stage kidney disease (ESKD) who undergo kidney transplantation incur significant risk of recurrent GN-related graft failure, but the risk in recipients with ESKD where GN was suspected but not biopsy proven (presumed/advanced GN) and when the cause of ESKD is unknown remains uncertain. Using the Australia and New Zealand Dialysis and Transplant registry, we examined the associations between primary kidney transplant recipients whose ESKD was attributed to: 1) commonly-recurring GN (i.e. IgA nephropathy, membranoproliferative GN, focal segmental glomerulosclerosis and membranous GN), 2) presumed/advanced GN, and 3) cause of ESKD unknown (uESKD) and GN-related graft failure using adjusted competing risk models. Of 5258 recipients followed for a median of 8 years, 3539 (67.3%) had commonly-recurring GN, 1195 (22.7%) presumed/advanced GN, and 524 (10.0%) uESKD. Compared to recipients with commonly-recurring GN, recipients with presumed/advanced GN or uESKD experienced a low incidence of GN-related graft failure (<1%) and a lower hazard of GN-related graft failure (adjusted sub-distribution hazard ratio [HR] 0.28 [95%CI 0.15-0.54,p < 0.001] and 0.20 [95%CI 0.06-0.64,p = 0.007], respectively). People with ESKD attributed to either presumed/advanced GN or unknown cause face a very low risk of graft failure secondary to GN recurrence after transplantation.

Highlights

Primary glomerulonephritis (GN) is one of the leading causes of end-stage kidney disease (ESKD) in Australia and worldwide, affecting up to 20% of patients commencing renal replacement therapy[1,2] and up to 40% of those who receive a kidney transplant[3,4,5,6]
There were 5258 recipients included in this study, of whom 3539 (67.3%) had commonly-recurring GN, 1195 (22.7%) had presumed/advanced GN, and 524 (10.0%) had uESKD
We found that GN-related graft failure was an uncommon event among these two groups after kidney transplantation, affecting less than 1% after a median follow-up period of 8 years

Summary

Introduction

Primary glomerulonephritis (GN) is one of the leading causes of end-stage kidney disease (ESKD) in Australia and worldwide, affecting up to 20% of patients commencing renal replacement therapy[1,2] and up to 40% of those who receive a kidney transplant[3,4,5,6]. The risks of GN recurrence and recurrence causing graft loss after transplantation remain unknown for patients with presumed or advanced GN and those with an unknown cause of ESKD. We sought to test the hypothesis that patients with ESKD secondary to presumed or advanced GN or an unknown cause have a low risk of GN-related graft failure compared to those with commonly-recurring GN. The primary aim of this study was to compare the risks of GN-related graft failure between kidney transplant recipients with presumed/advanced GN, ESKD from an unknown cause (uESKD) and those with ESKD secondary to biopsy-proven commonly-recurring GN, using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry

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Conclusion