Recurrent glomerulonephritis following renal transplantation and impact on graft survival

S. H. Jiang,A. L. Kennard,G. D. Walters

doi:10.1186/s12882-018-1135-7

Abstract

BackgroundRecurrence of primary glomerulonephritis in the post-transplant period has been described in the literature but the risk remains poorly quantified and its impact on allograft outcomes and implications for subsequent transplants remain under-examined. Here we describe the rates and timing of post-transplant glomerulonephritis recurrence for IgA nephropathy, focal segmental glomerulosclerosis, mesangiocapillary GN and membranous GN based on 28 years of ANZDATA registry transplant data.MethodsWe investigated the rates of GN recurrence and subsequent graft outcomes in 7236 patient from 28 years of ANZDATA transplant registry data. Data were analysed in R, using Kaplan Meier Survival analysis and adjusted analyses performed using Cox Proportional Hazards methods. A competing risk model was also analysed.ResultsGN recurrence occurred in 10.5% of transplants and was most common in mesangiocapillary GN. Median time to recurrence was shorter for FSGS compared to IGAN. GN recurrence was less common in patients over 50 years of age and after unrelated kidney donation. We identified a significantly higher risk of recurrence in secondary grafts following recurrence in a primary allograft for FSGS (RR 5.70, 95 CI: 2.41–13.5, p < 0.001) but not IGAN, MCGN or MN. At 10 years, recurrence occurs in 8.7, 10.8, 13.1, and 13.4% of allografts for FSGS, IGAN, MCGN and MN respectively. In all GN, recurrence significantly reduced death censored graft survival at 5 and 10 years.ConclusionsGN recurrence occurs in a minority of patients at a significantly different rate for each GN. After a recurrence, there is no evidence for an increased risk of further recurrence in a subsequent graft except in FSGS.

Highlights

Recurrence of primary glomerulonephritis in the post-transplant period has been described in the literature but the risk remains poorly quantified and its impact on allograft outcomes and implications for subsequent transplants remain under-examined
To determine the consequences in subsequent kidney allografts we examined the incidence and timing of allograft loss due to biopsy-proven recurrence of GN from the Australia and New Zealand Dialysis and Transplant registry (ANZDATA), evaluating risk factors for allograft loss and the impact of GN recurrence in first kidney allografts on subsequent kidney transplants based on 28 years of transplant registry data
The majority of transplants performed for GN within this period were primary allografts (n = 6475, 89.5%) followed by secondary (n = 686, 9.5%) and subsequent allografts (n = 75, 1%)

Summary

Introduction

Recurrence of primary glomerulonephritis in the post-transplant period has been described in the literature but the risk remains poorly quantified and its impact on allograft outcomes and implications for subsequent transplants remain under-examined. The risk of recurrence and its impact on outcomes are important questions for patients and clinicians in considering transplantation. It is unclear how GN recurrence in a first allograft impacts the risks of recurrence and graft survival in subsequent kidney transplants. To determine the consequences in subsequent kidney allografts we examined the incidence and timing of allograft loss due to biopsy-proven recurrence of GN from the Australia and New Zealand Dialysis and Transplant registry (ANZDATA), evaluating risk factors for allograft loss and the impact of GN recurrence in first kidney allografts on subsequent kidney transplants based on 28 years of transplant registry data

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