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Amir Kamal Aziz, Christiane Mousson, Francois Berthoux, Didier Ducloux, Jean-Marc Chalopin
Ann Transplant 2012; 17(3): 45-51
Background: IgA nephropathy (IgAN) is the causative disease of at most 10% of patients on dialysis and waiting for kidney transplantation. The disease can recur on the graft and it is important to know the exact impact of such recurrence on overall results of transplantation in this subgroup of young recipients.
Material/Methods: This is a retrospective study done in two closed centers over three decades with a final number of 142 recipients (111 men; median age of 42.2 years at surgery) with biopsy-proven IgAN among 1979 transplanted patients (7.2%). The mean follow-up time was 6.6 years. Recurrence was defined clinically as proteinuria over 1 g/day ± haematuria and associated with ≥1+ IgA mesangial deposits on the graft biopsy. We used Cox regression and Kaplan-Meier survival curves to study the event.
Results: Patient survival was excellent: 92% at 10 y; graft survival was 53% at 10y and similar to other recipients. The clinico-pathological (full) recurrence (CPR) was observed overall in 25 cases (17.6%) leading to graft loss in 10 cases (7%). The cumulative rate at 10 y of full recurrence and graft loss due to CPR was 21% and 13% respectively. We could not demonstrate any major influence of immunosuppression (induction or maintenance) or other factors on full recurrence. In addition, 10.5% of recipients disclosed only pathological recurrence without significant clinical consequences.
Conclusions: Despite significant prevalence of full recurrence after grafting, the overall good results observed still validate renal transplantation in this subgroup of IgAN recipients.