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09 March 2018 : Original article  

Clinical Features, Treatment and Prognostic Factors of Post-Transplant Immunoglobulin A Nephropathy

Diogo Buarque Cordeiro Cabral1ABCDEF*, Tainá Veras de Sandes-Freitas2ACDEF, José Osmar Medina-Pestana3ADEF, Gianna Mastroianni-Kirsztajn1ACDEF

DOI: 10.12659/AOT.907167

Ann Transplant 2018; 23:166-175

Abstract

BACKGROUND: Initially described as a relatively benign condition, recent studies report graft loss in up to 50% of the patients with post-transplant IgA nephropathy. There is no evidence for the best therapeutic approach, and prognostic factors remain to be elucidated.

MATERIAL AND METHODS: Single center retrospective analysis of patients >12 years old, with clinically relevant post-transplant IgA nephropathy (proteinuria ≥1.0 g/g and/or graft dysfunction) and ≥6 months follow-up after diagnosis (n=47).

RESULTS: Living donor transplants represented 85% of cases. Dysmorphic hematuria (100%), blood pressure elevation (95.7%), renal dysfunction (70.2%) and subnephrotic proteinuria (60.6%) predominated at presentation. Using the Oxford Classification, mesangial proliferation was the main histological lesion (91%). Treatment consisted mostly of blockade of the renin angiotensin system (89.4%) and modification of immunosuppression (85.1%), mainly by increasing oral steroids dose (83%), with venous pulse therapy in 63.8% of cases. Partial and complete remission occurred in 48.9% and 17% of cases, respectively. One patient died (sepsis) and 15 patients (31.9%) lost their grafts due to nephropathy. The percentage of decrease in glomerular filtration rate at diagnosis was independently associated with partial remission (HR 0.97, 95% CI 0.94–0.99, p=0.01) and graft loss (HR 1.13, 95% CI 1.06–1.20, p<0.001). Deceased donor (HR 28.04, 95% CI 4.41–178.39, p<0.001) and donor age (HR 1.1, 95% CI 1.04–1.16, p=0.001) were also risk factors for graft loss.

CONCLUSIONS: Despite treatment, most patients with post-transplant IgA nephropathy in this cohort study presented unfavorable outcomes, and graft dysfunction at diagnosis appeared to be the main prognostic marker.

Keywords: Glomerulonephritis, IGA, Immunosuppressive Agents, Kidney Transplantation

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358