Tonsillectomy and IgA Nephropathy Recurrence After Kidney Transplantation.

Abstract

[Background and purpose] The pathophysiology of IgA nephropathy (IgAN) remains poorly understood, although it frequently recurs after kidney transplantation, and its recurrence has been reported to depend on some factors. We studied a retrospective single-center analysis of renal transplant recipients with IgAN as the cause of end-stage renal failure to examine factors that may affect IgAN recurrence after kidney transplantation and the preventative and therapeutic effects of tonsillectomy on IgAN recurrence. [Material and method] From January 1987 to December 2012, 126 kidney transplantations were performed at Ryuku University Hospital, among which 14 cases (10 men; and 4 women) were identified with IgAN as their primary disease. Their mean age at transplantation was 38.1 ± 8.4 years.Donor types were as follows: 2 cadaveric, and 12 living (10 related; 2 unrelated). Tonsillectomy was performed for 8 cases; 2 were for therapeutic purposes for IgAN recurrence, and 6 were to prevent IgAN recurrence. IgAN recurrence diagnosis was based on light microscopic findings showing mesangioproliferative changes and mesangial IgA deposition on the basis of immunofluorescence analysis. [Result] Among the 14 patients, 2 cases were identified as IgAN recurrence based on episode biopsies. Both the recurrent cases had living related kidney donors. One patient with recurrent transplant IgAN progressed to graft failure 2.0 years after tonsillectomy, whereas the other subsequently retained renal function for 7.0 years. No pathological IgAN recurrence was found in 6 preventative tonsillectomy cases and in 2 cadaveric transplants that did not undergo tonsillectomy. Among 6 preventative tonsillectomy patients, 5 had improved urinary findings (protein urine and/or microscopic hematuria) after tonsillectomy. The 10 years living kidney donor graft survival rate of the IgAN group was lower than that of the non IgAN group (50 % vs. 88 %; P< 0.05). [Conclusion] Our data suggest that IgAN recurs more frequently after living related kidney transplantation than with cadaveric and living unrelated donor transplantation. Furthermore, no pathological IgAN recurrence was found after preventative tonsillectomy, and it was found that tonsillectomy could improve urinary findings. Thus, tonsillectomy has preventive and/or therapeutic effects for IgAN recurrence after kidney transplantation.