1
|
Santos AH, Mehta R, Alquadan K, Ibrahim H, Leghrouz MA, Belal A, Wen X. Age-modified risk factors for mortality of non-elderly adult kidney transplant recipients: a retrospective database analysis. Int Urol Nephrol 2024:10.1007/s11255-024-04132-3. [PMID: 38922533 DOI: 10.1007/s11255-024-04132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE We aimed to investigate the role of the recipient's age strata in modifying the associations between risk factors and mortality in non-elderly adult kidney transplant (KT) recipients (KTR). METHODS We stratified 108,695 adult KTRs between 2000 and 2016 with conditional 1-year survival after KT into cohorts based on age at transplant: 18-49 years and 50-64 years. We excluded KTRs aged < 18 years or > / = 65 years. KTRs were observed for 5 years during the 2nd through 6th years post-KT for the outcome, all-cause mortality. RESULTS Increasing recipient age strata (18-49-year-old and 50-64-year-old) correlated with decreasing 6-year post-KT survival rates conditional on 1-year survival (79% and 57%, respectively, p < 0.0001). Middle adult age stratum was associated with a higher risk of all-cause mortality than young adult age stratum in KTRs of Hispanic/Latino and other races [HR = 1.23, 95% CI = 1.04-1.45 and HR = 1.51, 95% CI = 1.16-1.97, respectively] and with a primary native renal diagnosis of hypertension or glomerulonephritis [HR = 1.32, 95% CI = 1.12-1.55 and HR = 1.29, 95% CI = 1.10-151, respectively]. When compared with the young adult age stratum, the middle adult age stratum had a mitigating effect on the higher risk of mortality associated with sirolimus-mycophenolate or sirolimus-tacrolimus than the standard calcineurin inhibitor-mycophenolate regimen [HR = 0.75, 95% CI = 0.57-0.99 and HR = 0.71, 95% CI = 0.57-0.89, respectively]. CONCLUSION Among adult non-elderly KTRs, the age strata, 18-49 years, and 50-64 years, have varying modifying effects on the strength and direction of associations between some specific risk factors and all-cause mortality.
Collapse
Affiliation(s)
- Alfonso H Santos
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA.
| | - Rohan Mehta
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA
| | - Kawther Alquadan
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA
| | - Hisham Ibrahim
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA
| | - Muhannad A Leghrouz
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA
| | - Amer Belal
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Road, Medical Science Bldg., Room NG-4, Gainesville, FL, 32610, USA
| | - Xuerong Wen
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| |
Collapse
|
2
|
Xie K, Chen J, Liu L, Wang R, Gao B, Hu X, Tang X, Jin Z, Zhang M, Han Y, Song T, Wen J, Zhang J. Long-term kidney transplant outcomes in Chinese patients with primary glomerulonephritis: A multicenter study in China. Chin Med J (Engl) 2024; 137:1492-1494. [PMID: 38630935 PMCID: PMC11188909 DOI: 10.1097/cm9.0000000000003107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Indexed: 04/19/2024] Open
Affiliation(s)
- Kenan Xie
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, China
| | - Jinsong Chen
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, China
| | - Longshan Liu
- Department of Organ Transplantation, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Rending Wang
- Department of Kidney Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China
| | - Baoshan Gao
- Department II of Urology, First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Xiaopeng Hu
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Xiaotian Tang
- Department of Urology, The Secend Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Zheng Jin
- Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, Shaanxi 710061, China
| | - Ming Zhang
- Department of Liver Surgery, Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital, Shanghai 200127, China
| | - Yong Han
- Department of Respiratory and Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Beijing Key Laboratory of OTIR, Beijing 100091, China
| | - Turen Song
- Department of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiqiu Wen
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, China
| | - Jiong Zhang
- Department of Nephrology, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, China
| |
Collapse
|
3
|
Trujillo H, Caravaca-Fontán F, Praga M. Ten tips on immunosuppression in primary membranous nephropathy. Clin Kidney J 2024; 17:sfae129. [PMID: 38915435 PMCID: PMC11195618 DOI: 10.1093/ckj/sfae129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Indexed: 06/26/2024] Open
Abstract
Membranous nephropathy (MN) management poses challenges, particularly in selecting appropriate immunosuppressive treatments (IST) and monitoring disease progression and complications. This article highlights 10 key tips for the management of primary MN based on current evidence and clinical experience. First, we advise against prescribing IST to patients without nephrotic syndrome (NS), emphasizing the need for close monitoring of disease progression. Second, we recommend initiating IST in patients with persistent NS or declining kidney function. Third, we suggest prescribing rituximab (RTX) or RTX combined with calcineurin inhibitors in medium-risk patients. Fourth, we propose cyclophosphamide-based immunosuppression for high-risk patients. Fifth, we discourage the use of glucocorticoid monotherapy or mycophenolate mofetil as initial treatments. Sixth, we underscore the importance of preventing infectious complications in patients receiving IST. Seventh, we emphasize the need for personalized monitoring of IST by closely measuring kidney function, proteinuria, serum albumin and anti-M-type phospholipase A2 receptor levels. Eighth, we recommend a stepwise approach in the treatment of resistant disease. Ninth, we advise adjusting treatment for relapses based on individual risk profiles. Finally, we caution about the potential recurrence of MN after kidney transplantation and suggest appropriate monitoring and treatment strategies for post-transplantation MN. These tips provide comprehensive guidance for clinicians managing MN, aiming to optimize patient outcomes and minimize complications.
Collapse
Affiliation(s)
- Hernando Trujillo
- Department of Nephrology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Fernando Caravaca-Fontán
- Department of Nephrology, Hospital Universitario, 12 de Octubre, Madrid, Spain
- Instituto de Investigación Hospital, 12 de Octubre (i+12), Madrid, Spain
| | - Manuel Praga
- Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
4
|
Garland S, Pullerits K, Chukwu CA, Chinnadurai R, Middleton R, Kalra PA. The effect of primary renal disease upon outcomes after renal transplant. Clin Transplant 2024; 38:e15216. [PMID: 38450843 DOI: 10.1111/ctr.15216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND This study investigated whether nature of primary renal disease affects clinical outcomes after renal transplantation at a single center in the United Kingdom. METHODS This was a retrospective cohort study of 961 renal transplant recipients followed up at a large renal center from 2000 to 2020. Separation of diseases responsible for end-stage kidney disease included glomerulonephritis, diabetic kidney disease, hypertensive nephropathy, autosomal dominant polycystic kidney disease, unknown cause, other causes and chronic pyelonephritis. Outcome data included graft loss, cardiovascular events, malignancy, post-transplant diabetes mellitus and death, analyzed according to primary disease type. RESULTS The mean age at transplantation was 47.3 years. During a mean follow-up of 7.6 years, 18% of the overall cohort died corresponding to an annualised mortality rate of 2.3%. Death with a functioning graft occurred at a rate of 2.1% per annum, with the highest incidence observed in in patients with diabetic kidney disease (4.1%/year). Post-transplant cardiovascular events occurred in 21% of recipients (2.8% per year), again highest in recipients with diabetic kidney disease (5.1%/year) and hypertensive nephropathy (4.5%/year). Post-transplant diabetes mellitus manifested in 19% of the cohort at an annualized rate of2.1% while cancer incidence stood at 9% with an annualized rate of 1.1% . Graft loss occurred in 6.8% of recipients at the rate of1.2% per year with chronic allograft injury, acute rejection and recurrent glomerulonephritis being the predominant causative factors. Median + IQR dialysis-free survival of the whole cohort was 16.2 (9.9 - > 20) years, being shortest for diabetic kidney disease (11.0 years) and greatest for autosomal dominant polycystic kidney disease (18.2 years) .The collective mean decline in eGFR over time was -1.14ml/min/year. Recipients with Pre-transplant diabetic kidney disease exhibited the fastest rate of decline(-2.1ml/min/year) a statistically significant difference in comparison to the other native kidney diseases with Autosomal dominant polycystic kidney disease exhibiting the lowest rate of decline(-0.05ml/min/year) CONCLUSION: Primary renal disease can influence the outcome after renal transplantation, with patients with prior diabetic kidney disease having the poorest outcome in terms of dialysis-free survival and loss of transplant function. Autosomal polycystic kidney disease, other cause and unknown cause had the best outcomes compared to other primary renal disease groups.
Collapse
Affiliation(s)
| | | | - Chukwuma A Chukwu
- Faculty of Biology, Medicine and Health, Division of cardiovascular medicine, The University of Manchester, Manchester, UK
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Rajkumar Chinnadurai
- Faculty of Biology, Medicine and Health, Division of cardiovascular medicine, The University of Manchester, Manchester, UK
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Rachel Middleton
- Faculty of Biology, Medicine and Health, Division of cardiovascular medicine, The University of Manchester, Manchester, UK
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Philip A Kalra
- Faculty of Biology, Medicine and Health, Division of cardiovascular medicine, The University of Manchester, Manchester, UK
- Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| |
Collapse
|
5
|
Bose B, Milanzi E, Pascoe EM, Johnson DW, Badve SV. The outcomes of patients with kidney failure due to focal segmental glomerulosclerosis (FSGS) in Australia and New Zealand: A cohort study using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). PLoS One 2023; 18:e0293721. [PMID: 37917639 PMCID: PMC10621846 DOI: 10.1371/journal.pone.0293721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The outcomes of patients with focal segmental glomerulosclerosis (FSGS) on kidney replacement therapy (KRT) have not been well described. This study evaluated the outcomes of patients with kidney failure due to FSGS on KRT including dialysis and kidney transplantation. METHOD AND MATERIALS All adult patients with kidney failure who commenced KRT in Australia and New Zealand from 15th of May 1963 to 31st of December 2018 were retrospectively extracted from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Outcomes of patients with FSGS were compared to those with other causes of kidney failure (non-FSGS). RESULTS 85,052 patients commenced KRT during the study period, of whom 2991 (3.5%) were patients with FSGS. Compared to patients with non-FSGS, patients with FSGS experienced similar mortality on dialysis (adjusted hazard ratio [aHR] 0.98, 95% CI 0.90-1.06, p = 0.55) and following kidney transplantation (aHR 0.92, 95% CI 0.73-1.15, p = 0.47). The risk of first kidney allograft loss was higher in patients with FSGS (aHR 1.20, 95% CI 1.04-1.37, p = 0.01). However, when death was analysed as a competing risk, the survival in both groups was similar (sub-hazard ratio [SHR] 1.09, 95% CI 0.94-1.28, p = 0.26). Patients with FSGS had a longer waiting time for kidney transplantation (aHR 0.92, 95% CI 0.86-0.98, p = 0.02) and experienced an increased risk of disease recurrence in the allograft (aHR 1.73, 95% CI 1.35-2.21, p<0.001). Compared to patients with other forms of glomerular disease, patients with FSGS experienced similar dialysis and transplant patient survival and death-censored rate of kidney transplantation and allograft loss but higher rates of primary kidney disease recurrence. CONCLUSION FSGS was associated with similar dialysis and transplant patient survival and death-censored first allograft loss compared to non-FSGS and other forms of glomerular disease.
Collapse
Affiliation(s)
- Bhadran Bose
- Australasian Kidney Trials Network, The University of Queensland, Queensland, Australia
- Department of Nephrology, Nepean Hospital, Kingswood, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia
| | - Elasma Milanzi
- Australasian Kidney Trials Network, The University of Queensland, Queensland, Australia
| | - Elaine M. Pascoe
- Australasian Kidney Trials Network, The University of Queensland, Queensland, Australia
- Centre for Kidney Disease Research, The University of Queensland, Queensland, Australia
| | - David W. Johnson
- Australasian Kidney Trials Network, The University of Queensland, Queensland, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia
- Centre for Kidney Disease Research, The University of Queensland, Queensland, Australia
- Division of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Sunil V. Badve
- Australasian Kidney Trials Network, The University of Queensland, Queensland, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia
- Department of Nephrology, St George Hospital, Sydney, Australia
| |
Collapse
|
6
|
Aguiar R, Bourmpaki E, Bunce C, Coker B, Delaney F, de Jongh L, Oliveira G, Weir A, Higgins F, Spiridou A, Hasan S, Smith J, Mulla A, Glampson B, Mercuri L, Montero R, Hernandez-Fuentes M, Roufosse CA, Simmonds N, Clatworthy M, McLean A, Ploeg R, Davies J, Várnai KA, Woods K, Lord G, Pruthi R, Breen C, Chowdhury P. Incidence, Risk Factors, and Effect on Allograft Survival of Glomerulonephritis Post-transplantation in a United Kingdom Population: Cohort Study. FRONTIERS IN NEPHROLOGY 2022; 2:923813. [PMID: 37675026 PMCID: PMC10479671 DOI: 10.3389/fneph.2022.923813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/17/2022] [Indexed: 09/08/2023]
Abstract
Background Post-transplant glomerulonephritis (PTGN) has been associated with inferior long-term allograft survival, and its incidence varies widely in the literature. Methods This is a cohort study of 7,623 patients transplanted between 2005 and 2016 at four major transplant UK centres. The diagnosis of glomerulonephritis (GN) in the allograft was extracted from histology reports aided by the use of text-mining software. The incidence of the four most common GN post-transplantation was calculated, and the risk factors for disease and allograft outcomes were analyzed. Results In total, 214 patients (2.8%) presented with PTGN. IgA nephropathy (IgAN), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), and membranoproliferative/mesangiocapillary GN (MPGN/MCGN) were the four most common forms of post-transplant GN. Living donation, HLA DR match, mixed race, and other ethnic minority groups were associated with an increased risk of developing a PTGN. Patients with PTGN showed a similar allograft survival to those without in the first 8 years of post-transplantation, but the results suggest that they do less well after that timepoint. IgAN was associated with the best allograft survival and FSGS with the worst allograft survival. Conclusions PTGN has an important impact on long-term allograft survival. Significant challenges can be encountered when attempting to analyze large-scale data involving unstructured or complex data points, and the use of computational analysis can assist.
Collapse
Affiliation(s)
- Rute Aguiar
- Department of Transplantation and Renal Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Elli Bourmpaki
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Catey Bunce
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Bola Coker
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Florence Delaney
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Leonardo de Jongh
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Giovani Oliveira
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Alistair Weir
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Finola Higgins
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Anastasia Spiridou
- Data Research, Innovation and Virtual Environments Unit (DRIVE), Great Ormond Street Hospital for Children National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Syed Hasan
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Jonathan Smith
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Abdulrahim Mulla
- National Institute for Health and Care Research (NIHR) Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare National Health Service (NHS) Trust, Hammersmith Hospital, London, United Kingdom
| | - Ben Glampson
- Research Informatics Team, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom
| | - Luca Mercuri
- National Institute for Health and Care Research (NIHR) Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare National Health Service (NHS) Trust, Hammersmith Hospital, London, United Kingdom
| | - Rosa Montero
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Guy’s & St Thomas’ National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | | | - Candice A. Roufosse
- Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Naomi Simmonds
- Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Menna Clatworthy
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Adam McLean
- Renal Section, Department of Medicine, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
| | - Rutger Ploeg
- Nuffield Department of Surgical Sciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Jim Davies
- National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre, Big Data Institute, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Department of Computer Science, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Kinga Anna Várnai
- National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre, Big Data Institute, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, Oxfordshire, United Kingdom
| | - Kerrie Woods
- National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre, Big Data Institute, University of Oxford, Oxford, Oxfordshire, United Kingdom
- Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, Oxfordshire, United Kingdom
| | - Graham Lord
- Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Rishi Pruthi
- Department of Transplantation and Renal Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Cormac Breen
- Department of Transplantation and Renal Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Paramit Chowdhury
- Department of Transplantation and Renal Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
7
|
Kidney transplantation outcomes in patients with IgA nephropathy and other glomerular and non-glomerular primary diseases in the new era of immunosuppression. PLoS One 2021; 16:e0253337. [PMID: 34403416 PMCID: PMC8370606 DOI: 10.1371/journal.pone.0253337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 06/02/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Kidney transplant (KTx) recipients with IgAN as primary disease, were compared with recipients with other causes of renal failure, in terms of long-term outcomes. METHODS Ninety-nine KTx recipients with end-stage kidney disease (ESKD) due to IgAN, were retrospectively compared to; i/ a matched case-control group of patients with non-glomerular causes of ESKD, and ii/ four control groups with ESKD due to glomerular diseases; 44 patients with primary focal segmental glomerulosclerosis (FSGS), 19 with idiopathic membranous nephropathy (IMN), 22 with lupus nephritis (LN) and 21 with pauci-immune glomerulonephritis (PIGN). RESULTS At end of the observation period, graft function and survival, were similar between KTx recipients with IgAN and all other groups, but the rate of disease recurrence in the graft differed significantly across groups. The rate of IgAN recurrence in the graft was 23.2%, compared to 59.1% (p<0.0001) in the FSGS group, 42.1% (p = 0.17) in the IMN group, and 0% in the LN and PIGN groups (p = 0.01). IgAN recipients, who were maintained with a regimen containing tacrolimus, experienced recurrence less frequently, compared to those maintained with cyclosporine (p = 0.01). Graft loss attributed to recurrence was significantly higher in patients with FSGS versus all others. CONCLUSION Recipients with IgAN as primary disease, experienced outcomes comparable to those of recipients with other causes of ESKD. The rate of IgAN recurrence in the graft was significantly lower than the rate of FSGS recurrence, but higher than the one recorded in recipients with LN or PIGN. Tacrolimus, as part of the KTx maintenance therapy, was associated with lower rates of IgAN recurrence in the graft, compared to the rate cyclosporine.
Collapse
|
8
|
Law S, Cohen O, Lachmann HJ, Rezk T, Gilbertson JA, Rowczenio D, Wechalekar AD, Hawkins PN, Motallebzadeh R, Gillmore JD. Renal transplant outcomes in amyloidosis. Nephrol Dial Transplant 2021; 36:355-365. [PMID: 33439995 DOI: 10.1093/ndt/gfaa293] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/07/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Outcomes after renal transplantation have traditionally been poor in systemic amyloid A (AA) amyloidosis and systemic light chain (AL) amyloidosis, with high mortality and frequent recurrent disease. We sought to compare outcomes with matched transplant recipients with autosomal dominant polycystic kidney disease (ADPKD) and diabetic nephropathy (DN), and identify factors predictive of outcomes. METHODS We performed a retrospective cohort study of 51 systemic AL and 48 systemic AA amyloidosis patients undergoing renal transplantation. Matched groups were generated by propensity score matching. Patient and death-censored allograft survival were compared via Kaplan-Meier survival analyses, and assessment of clinicopathological features predicting outcomes via Cox proportional hazard analyses. RESULTS One-, 5- and 10-year death-censored unadjusted graft survival was, respectively, 94, 91 and 78% for AA amyloidosis, and 98, 93 and 93% for AL amyloidosis; median patient survival was 13.1 and 7.9 years, respectively. Patient survival in AL and AA amyloidosis was comparable to DN, but poorer than ADPKD [hazard ratio (HR) = 3.12 and 3.09, respectively; P < 0.001]. Death-censored allograft survival was comparable between all groups. In AL amyloidosis, mortality was predicted by interventricular septum at end diastole (IVSd) thickness >12 mm (HR = 26.58; P = 0.03), while survival was predicted by haematologic response (very good partial or complete response; HR = 0.07; P = 0.018). In AA amyloidosis, recurrent amyloid was associated with elevated serum amyloid A concentration but not with outcomes. CONCLUSIONS Renal transplantation outcomes for selected patients with AA and AL amyloidosis are comparable to those with DN. In AL amyloidosis, IVSd thickness and achievement of deep haematologic response pre-transplant profoundly impact patient survival.
Collapse
Affiliation(s)
- Steven Law
- National Amyloidosis Centre, University College London, London, UK.,Department of Renal Medicine, Centre for Transplantation, University College London, London, UK
| | - Oliver Cohen
- National Amyloidosis Centre, University College London, London, UK
| | - Helen J Lachmann
- National Amyloidosis Centre, University College London, London, UK
| | - Tamer Rezk
- National Amyloidosis Centre, University College London, London, UK
| | | | - Dorota Rowczenio
- National Amyloidosis Centre, University College London, London, UK
| | | | - Philip N Hawkins
- National Amyloidosis Centre, University College London, London, UK
| | - Reza Motallebzadeh
- National Amyloidosis Centre, University College London, London, UK.,Department of Renal Medicine, Centre for Transplantation, University College London, London, UK.,Division of Surgical & Interventional Sciences, University College London, London, UK.,Institute of Immunity & Transplantation, University College London, London, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, London, UK.,Department of Renal Medicine, Centre for Transplantation, University College London, London, UK
| |
Collapse
|
9
|
Fakhouri F, Le Quintrec M, Frémeaux-Bacchi V. Practical management of C3 glomerulopathy and Ig-mediated MPGN: facts and uncertainties. Kidney Int 2020; 98:1135-1148. [PMID: 32622830 DOI: 10.1016/j.kint.2020.05.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/06/2020] [Accepted: 05/27/2020] [Indexed: 01/11/2023]
Abstract
In recent years, a substantial body of experimental and clinical work has been devoted to C3 glomerulopathy and Ig-mediated membranoproliferative glomerulonephritis. Despite the rapid accumulation of data, several uncertainties about these 2 rare forms of nephropathies persist. They concern their pathophysiology, classification, clinical course, relevance of biomarkers and of pathology findings, and assessment of the efficacy of the available therapies. The present review discusses the impact of these uncertainties on the clinical management of patients.
Collapse
Affiliation(s)
- Fadi Fakhouri
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Moglie Le Quintrec
- Department of nephrology, Université de Montpellier, CHU de Montpellier, Montpellier, France
| | - Véronique Frémeaux-Bacchi
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d'Immunologie and Paris University, Paris, France
| |
Collapse
|
10
|
Batal I, Vasilescu ER, Dadhania DM, Adel AA, Husain SA, Avasare R, Serban G, Santoriello D, Khairallah P, Patel A, Moritz MJ, Latulippe E, Riopel J, Khallout K, Swanson SJ, Bomback AS, Mohan S, Ratner L, Radhakrishnan J, Cohen DJ, Appel GB, Stokes MB, Markowitz GS, Seshan SV, De Serres SA, Andeen N, Loupy A, Kiryluk K, D'Agati VD. Association of HLA Typing and Alloimmunity With Posttransplantation Membranous Nephropathy: A Multicenter Case Series. Am J Kidney Dis 2020; 76:374-383. [PMID: 32359820 PMCID: PMC7483441 DOI: 10.1053/j.ajkd.2020.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE & OBJECTIVES Posttransplantation membranous nephropathy (MN) represents a rare complication of kidney transplantation that can be classified as recurrent or de novo. The clinical, pathologic, and immunogenetic characteristics of posttransplantation MN and the differences between de novo and recurrent MN are not well understood. STUDY DESIGN Multicenter case series. SETTING & PARTICIPANTS We included 77 patients from 5 North American and European medical centers with post-kidney transplantation MN (27 de novo and 50 recurrent). Patients with MN in the native kidney who received kidney allografts but did not develop recurrent MN were used as nonrecurrent controls (n = 43). To improve understanding of posttransplantation MN, we compared de novo MN with recurrent MN and then contrasted recurrent MN with nonrecurrent controls. FINDINGS Compared with recurrent MN, de novo MN was less likely to be classified as primary MN (OR, 0.04; P < 0.001) and had more concurrent antibody-mediated rejection (OR, 12.0; P < 0.001) and inferior allograft survival (HR for allograft failure, 3.2; P = 0.007). HLA-DQ2 and HLA-DR17 antigens were more common in recipients with recurrent MN compared with those with de novo MN; however, the frequency of these recipient antigens in recurrent MN was similar to that in nonrecurrent MN controls. Among the 93 kidney transplant recipients with native kidney failure attributed to MN, older recipient age (HR per each year older, 1.03; P = 0.02), recipient HLA-A3 antigen (HR, 2.5; P = 0.003), steroid-free immunosuppressive regimens (HR, 2.84; P < 0.001), and living related allograft (HR, 1.94; P = 0.03) were predictors of MN recurrence. LIMITATIONS Retrospective case series, limited sample size due to rarity of the disease, nonstandardized nature of data collection and biopsies. CONCLUSIONS De novo and recurrent MN likely represent separate diseases. De novo MN is associated with humoral alloimmunity and guarded outcome. Potential predisposing factors for recurrent MN include recipients who are older, recipient HLA-A3 antigen, steroid-free immunosuppressive regimen, and living related donor kidney.
Collapse
Affiliation(s)
- Ibrahim Batal
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY.
| | - Elena-Rodica Vasilescu
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Darshana M Dadhania
- Department of Medicine, Nephrology, Weill Cornell Medical College, New York, NY
| | | | - S Ali Husain
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Rupali Avasare
- Department of Medicine, Nephrology, Oregon Health & Science University, Portland, OR
| | - Geo Serban
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Dominick Santoriello
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Pascale Khairallah
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Ankita Patel
- Department of Medicine, Nephrology, Hackensack University Medical Center, Hackensack, NJ
| | - Michael J Moritz
- Department of Surgery, Lehigh Valley Health Network, Allentown, PA
| | - Eva Latulippe
- Department of Pathology, University Health Center of Quebec, Laval University, Québec, QC, Canada
| | - Julie Riopel
- Department of Pathology, University Health Center of Quebec, Laval University, Québec, QC, Canada
| | - Karim Khallout
- Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France
| | | | - Andrew S Bomback
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Sumit Mohan
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Lloyd Ratner
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Jai Radhakrishnan
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - David J Cohen
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Gerald B Appel
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Michael B Stokes
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Glen S Markowitz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Surya V Seshan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - Sacha A De Serres
- Renal Division, Department of Medicine, University Health Center of Quebec, Laval University, Québec, QC, Canada
| | - Nicole Andeen
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France
| | - Krzysztof Kiryluk
- Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY
| | - Vivette D D'Agati
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
11
|
Singh T, Astor BC, Zhong W, Mandelbrot DA, Maursetter L, Panzer SE. The association of acute rejection vs recurrent glomerular disease with graft outcomes after kidney transplantation. Clin Transplant 2019; 33:e13738. [PMID: 31630440 DOI: 10.1111/ctr.13738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/29/2019] [Accepted: 10/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has been shown that glomerulonephritis (GN) recurrence affects graft survival more than acute rejection. Thus, we assessed allograft survival after biopsy-confirmed diagnosis of acute rejection or recurrent GN in current era of immunosuppression. METHODS Allograft survival following a biopsy diagnosis of acute rejection or recurrent GN was determined in adult kidney transplant recipients from 1994 to 2013. A total of 306 patients (35%) with IgA, 298 (35%) with FSGS, 177 (21%) with lupus nephritis, and 81 (9%) with membranous nephropathy were followed for a median of 6.3 years. RESULTS Among the 862 transplant recipients with primary GN, allograft loss was similar following a biopsy diagnosis of acute rejection or recurrent glomerular disease (11.5 vs 14.2/100 person-years, P = .15). Differences in allograft survival emerged after 2.5 years following recurrent disease, with significantly higher graft failure in patients with FSGS, MN, or LN compared with IgA after recurrence of disease (16.7 vs 7.5/100 person-years, P = .05). The advantage in allograft survival for IgA patients did not achieve significance after acute rejection (P = .10 for IgA vs FSGS, MN, and LN). CONCLUSIONS Allograft survival was similar after disease recurrence or acute rejection after kidney transplant in patients with ESRD due to GN.
Collapse
Affiliation(s)
- Tripti Singh
- Department of Medicine, Division of Nephrology, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| | - Brad C Astor
- Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Weixiong Zhong
- Department of Pathology, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| | - Didier A Mandelbrot
- Department of Medicine, Division of Nephrology, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| | - Laura Maursetter
- Department of Medicine, Division of Nephrology, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| | - Sarah E Panzer
- Department of Medicine, Division of Nephrology, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA
| |
Collapse
|
12
|
Leon J, Pérez-Sáez MJ, Batal I, Beck LH, Rennke HG, Canaud G, Legendre C, Pascual J, Riella LV. Membranous Nephropathy Posttransplantation: An Update of the Pathophysiology and Management. Transplantation 2019; 103:1990-2002. [PMID: 31568231 DOI: 10.1097/tp.0000000000002758] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Membranous nephropathy (MN) is a common cause of nephrotic syndrome after transplantation and is associated with an increased risk of allograft loss. MN may occur either as a recurrent or as a de novo disease. As in native kidneys, the pathophysiology of the MN recurrence is in most cases associated with antiphospholipid A2 receptor antibodies. However, the posttransplant course has some distinct features when compared with primary MN, including a lower chance of spontaneous remission and a greater requirement for adjuvant immunosuppressive therapy to induce complete remission. Although the efficacy of rituximab in primary MN is now well established, no randomized studies have assessed its effectiveness in MN after transplant, and there are no specific recommendations for the management of these patients. This review aims to synthesize and update the pathophysiology of posttransplant MN, as well as to address unsolved issues specific to transplantation, including the prognostic value of antiphospholipid A2 receptor, the risk of living-related donation, the link between de novo MN and rejection, and different therapeutic strategies so far deployed in posttransplant MN. Lastly, we propose a management algorithm for patients with MN who are planning to receive a kidney transplant, including pretransplant considerations, posttransplant monitoring, and the clinical approach after the diagnosis of recurrence.
Collapse
Affiliation(s)
- Juliette Leon
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Nephrology-Transplantation, Necker Hospital, APHP, Paris, France
| | - María José Pérez-Sáez
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Ibrahim Batal
- Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Laurence H Beck
- Division of Nephrology, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Helmut G Rennke
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Guillaume Canaud
- Department of Nephrology-Transplantation, Necker Hospital, APHP, Paris, France
| | - Christophe Legendre
- Department of Nephrology-Transplantation, Necker Hospital, APHP, Paris, France
| | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Leonardo V Riella
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
13
|
Long-term outcomes of patients with end-stage kidney disease due to membranous nephropathy: A cohort study using the Australia and New Zealand Dialysis and Transplant Registry. PLoS One 2019; 14:e0221531. [PMID: 31442267 PMCID: PMC6707602 DOI: 10.1371/journal.pone.0221531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/08/2019] [Indexed: 01/17/2023] Open
Abstract
Background Clinical outcomes of patients with end-stage kidney disease (ESKD) secondary to membranous nephropathy (MN) have not been well described. This study aimed to evaluate patient and/or allograft outcomes of dialysis or kidney transplantation in patients with ESKD secondary to MN. Material and methods All adult patients with ESKD commencing renal replacement therapy in Australia and New Zealand from January 1998 to December 2010 were extracted retrospectively from ANZDATA registry on 31st December 2013. Outcomes of MN were compared to other causes of ESKD. In a secondary analysis, outcomes of MN were compared to all patients with ESKD due to other forms of glomerulonephritis. Results Of 32,788 included patients, 417 (1.3%) had MN. Compared to other causes of ESKD, MN experienced lower mortality on dialysis (adjusted hazard ratio [aHR] 0.79, 95% CI 0.68–0.92, p = 0.002) and following kidney transplantation (aHR 0.57, 95% CI 0.33–0.97, p = 0.04), had a higher risk of death-censored kidney allograft failure (aHR 1.55, 95% CI: 1.00–2.41, p = 0.05) but comparable risk of overall kidney allograft failure (aHR 1.35, 95% CI 0.91–2.01, p = 0.13). Similar results were obtained using competing-risk regression analyses. MN patients were significantly more likely to receive a kidney transplant (aHR 1.38, 95% CI 1.16–1.63, p<0.001) and to experience primary kidney disease recurrence in the allograft (aHR 4.92, 95% CI 3.02–8.01, p<0.001). Compared to other forms of glomerulonephritis, MN experienced comparable dialysis and transplant patient survival, but higher rates of kidney transplantation, primary renal disease recurrence and death-censored allograft failure. Conclusion MN was associated with superior survival on dialysis and following kidney transplantation compared to patients with other causes of ESKD, and comparable patient survival compared to patients with other forms of glomerulonephritis. However, patients with MN exhibited a higher rate of death-censored allograft loss as a result of primary kidney disease recurrence.
Collapse
|
14
|
Moroni G, Belingheri M, Frontini G, Tamborini F, Messa P. Immunoglobulin A Nephropathy. Recurrence After Renal Transplantation. Front Immunol 2019; 10:1332. [PMID: 31275309 PMCID: PMC6593081 DOI: 10.3389/fimmu.2019.01332] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/28/2019] [Indexed: 12/28/2022] Open
Abstract
IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. The disease generally runs an indolent course but may lead to ESRD in 20-30% of patients in 20 years or more after diagnosis. Patients with IgA nephropathy are ideal candidates for renal transplant because they are generally relatively young and with few comorbidities. Their graft survival is better or comparable to that of controls at 10 years, though few data are available after 10 years of follow-up. Recurrence of the original disease in the graft is a well-known complication of transplant in IgAN and is a significant cause of deterioration of graft function. Recurrent IgAN rarely manifests clinically before 3 years post transplantation. Recurrence rate is estimated to be around 30% with considerable differences among different series. Despite these factors there is no certain recurrence predictor, young age at renal transplant, rapid progression of the original disease and higher levels of circulating galactose-deficient IgA1 and IgA-IgG immune complexes are all associated with a higher rate of recurrence. Which pathogenetic mechanisms are responsible for the progression of the recurrence to graft function deterioration, and what therapy can prevent or slow down the progression of the disease in the graft, are open questions. The aim of this review is to describe the clinical outcome of renal transplantation in IgA patients with attention to the rate and the predictors of recurrence and to discuss the available therapeutic options for the management of recurrence.
Collapse
Affiliation(s)
- Gabriella Moroni
- Dialysis, and Renal Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mirco Belingheri
- Dialysis, and Renal Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Frontini
- Dialysis, and Renal Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Tamborini
- Dialysis, and Renal Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Piergiorgio Messa
- Dialysis, and Renal Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
15
|
Uffing A, Pérez-Sáez MJ, La Manna G, Comai G, Fischman C, Farouk S, Manfro RC, Bauer AC, Lichtenfels B, Mansur JB, Tedesco-Silva H, Kirsztajn GM, Manonelles A, Bestard O, Riella MC, Hokazono SR, Arias-Cabrales C, David-Neto E, Ventura CG, Akalin E, Mohammed O, Khankin EV, Safa K, Malvezzi P, O'Shaughnessy MM, Cheng XS, Cravedi P, Riella LV. A large, international study on post-transplant glomerular diseases: the TANGO project. BMC Nephrol 2018; 19:229. [PMID: 30208881 PMCID: PMC6136179 DOI: 10.1186/s12882-018-1025-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 08/28/2018] [Indexed: 12/14/2022] Open
Abstract
Background Long-term outcomes in kidney transplantation (KT) have not significantly improved during the past twenty years. Despite being a leading cause of graft failure, glomerular disease (GD) recurrence remains poorly understood, due to heterogeneity in disease pathogenesis and clinical presentation, reliance on histopathology to confirm disease recurrence, and the low incidence of individual GD subtypes. Large, international cohorts of patients with GD are urgently needed to better understand the disease pathophysiology, predictors of recurrence, and response to therapy. Methods The Post-TrANsplant GlOmerular Disease (TANGO) study is an observational, multicenter cohort study initiated in January 2017 that aims to: 1) characterize the natural history of GD after KT, 2) create a biorepository of saliva, blood, urine, stools and kidney tissue samples, and 3) establish a network of patients and centers to support novel therapeutic trials. The study includes 15 centers in America and Europe. Enrollment is open to patients with biopsy-proven GD prior to transplantation, including IgA nephropathy, membranous nephropathy, focal and segmental glomerulosclerosis, atypical hemolytic uremic syndrome, dense-deposit disease, C3 glomerulopathy, complement- and IgG-positive membranoproliferative glomerulonephritis or membranoproliferative glomerulonephritis type I-III (old classification). During phase 1, patient data will be collected in an online database. The biorepository (phase 2) will involve collection of samples from patients for identification of predictors of recurrence, biomarkers of disease activity or response to therapy, and novel pathogenic mechanisms. Finally, through phase 3, we will use our multicenter network of patients and centers to launch interventional studies. Discussion Most prior studies of post-transplant GD recurrence are single-center and retrospective, or rely upon registry data that frequently misclassify the cause of kidney disease. Systematically determining GD recurrence rates and predictors of clinical outcomes is essential to improving post-transplant outcomes. Furthermore, accurate molecular phenotyping and biomarker development will allow better understanding of individual GD pathogenesis, and potentially identify novel drug targets for GD in both native and transplanted kidneys. The TANGO study has the potential to tackle GD recurrence through a multicenter design and a comprehensive biorepository.
Collapse
Affiliation(s)
- Audrey Uffing
- Renal Division, Brigham & Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Maria José Pérez-Sáez
- Renal Division, Brigham & Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA.,Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Clara Fischman
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Levy Place, New York, NY, 10029, USA
| | - Samira Farouk
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Levy Place, New York, NY, 10029, USA
| | - Roberto Ceratti Manfro
- Renal Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Andrea Carla Bauer
- Renal Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruno Lichtenfels
- Renal Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana B Mansur
- Renal Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Hélio Tedesco-Silva
- Renal Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Gianna M Kirsztajn
- Renal Division, Hospital do Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Anna Manonelles
- Renal Division, Bellvitge University Hospital, Barcelona, Spain
| | - Oriol Bestard
- Renal Division, Bellvitge University Hospital, Barcelona, Spain
| | | | | | | | - Elias David-Neto
- Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Enver Akalin
- Montefiore Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Omar Mohammed
- Montefiore Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eliyahu V Khankin
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kassem Safa
- Transplant Center and Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paolo Malvezzi
- Service de Néphrologie Dialyse, Aphérèses et Transplantation, Grenoble University Hospital, Grenoble, France
| | | | - Xingxing S Cheng
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Paolo Cravedi
- Renal Division, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Levy Place, New York, NY, 10029, USA.
| | - Leonardo V Riella
- Renal Division, Brigham & Women's Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA.
| |
Collapse
|
16
|
Dziewanowski K, Myślak M, Drozd R, Krzystolik E, Krzystolik A, Ostrowski M, Droździk M, Tejchman K, Kozdroń K, Sieńko J. Factors Influencing Long-Term Survival of Kidney Grafts Transplanted From Deceased Donors-Analysis Based on a Single-Center Experience. Transplant Proc 2018; 50:1281-1284. [PMID: 29880347 DOI: 10.1016/j.transproceed.2018.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/19/2017] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Kidney transplantation is a routine procedure in the treatment of patients with kidney failure and requires collaboration of experts from different disciplines. Improvements in the procedure result from numerous factors. METHODS The analyzed group consisted of 150 patients divided into 2 equal subgroups: long-term (>15 years) and short-term (<6 years) graft survival. The following factors were taken into consideration: graft survival time, HLA mismatches, recipient sex, sex compatibility, panel reactive antibodies (PRA), cold ischemia time (CIT), and cause of kidney insufficiency. Factors were analyzed in groups with the use of Student t and chi-square tests, Kruskal-Wallis analysis of variance (ANOVA), and multifactorial ANOVA. RESULTS Basic statistical analysis revealed no significance between long-term and short-term survival groups in HLA mismatches, recipient sex, or sex compatibility. There was a very significant difference in CIT. ANOVA revealed no statistical difference between groups in recipient sex, sex compatibility, or recipient disease. There were more patients in the group with long-term survival with lower PRA. There were more women in the group with long-term survival who received kidneys from men. Multifactorial analysis revealed no interactions or independent influence of the selected factors. CONCLUSIONS CIT was a strong independent factor influencing graft survival. Recipient sex and cause of kidney insufficiency seemed to have no impact. Lower PRA was positively correlated with long-term survival. Women who received kidneys from men lived longer with functioning grafts.
Collapse
Affiliation(s)
- K Dziewanowski
- Center of Nephrology and Kidney Transplantation, Regional Hospital, Szczecin, Poland
| | - M Myślak
- Center of Nephrology and Kidney Transplantation, Regional Hospital, Szczecin, Poland
| | - R Drozd
- Center of Nephrology and Kidney Transplantation, Regional Hospital, Szczecin, Poland
| | - E Krzystolik
- Center of Nephrology and Kidney Transplantation, Regional Hospital, Szczecin, Poland
| | - A Krzystolik
- Department of Cardiology, Regional Hospital, Szczecin, Poland
| | - M Ostrowski
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - M Droździk
- Department of Clinical and Experimental Pharmacology, Pomeranian Medical University, Szczecin, Poland
| | - K Tejchman
- Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland.
| | - K Kozdroń
- Department of Cardiology, Regional Hospital, Szczecin, Poland
| | - J Sieńko
- Department of Cardiology, Regional Hospital, Szczecin, Poland
| |
Collapse
|
17
|
Singh T, Astor B, Zhong W, Mandelbrot D, Djamali A, Panzer S. Kidney Transplant Recipients With Primary Membranous Glomerulonephritis Have a Higher Risk of Acute Rejection Compared With Other Primary Glomerulonephritides. Transplant Direct 2017; 3:e223. [PMID: 29184911 PMCID: PMC5682767 DOI: 10.1097/txd.0000000000000736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/01/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite being the leading cause of graft failure, there is a lack of published data about the rates of rejection in kidney transplant patients with glomerulonephritis as the cause of end-stage renal disease. METHODS We examined all consecutive adult (>18 years) renal transplant recipients with biopsy-proven native renal glomerular disease who underwent kidney transplant between 1994 and 2013. Glomerulonephritis groups included were IgA nephropathy (IgAN) (N = 306), focal segmental glomerulosclerosis (FSGS) (N = 298), membranous nephropathy (MN) (N = 81), and lupus nephritis (LN) (N = 177). RESULTS In the total cohort of 862 patients, 363 patients had an episode of acute rejection during the follow-up period of 19 years (incidence rate of 7.2% per year). Forty-five of 81 patients with MN had an episode of acute rejection during the follow-up period. Patients with MN had significantly higher incidence of acute rejection (12.1 per 100 person years, P < 0.05) in comparison to IgAN (7.2 per 100 person years), FSGS (7.4 per 100 person years), and LN (7.9 per 100 person years). Patients with MN had 1.9 times higher risk of developing acute rejection after transplant in comparison to IgAN (P < 0.005). In patients with MN, 33 of 45 (73.3%) rejection events were acute cellular rejection, 8 (17.8%) of 45 were acute antibody-mediated rejection and 6 of 45 (13.3%) were combined cellular and antibody-mediated acute rejection. Despite higher rates of acute rejection, 10-year allograft survival was similar in all subgroups. CONCLUSIONS Patients with MN have higher incidence of acute rejection after kidney transplant but have similar 10-year allograft survival in comparison to the other glomerular diseases like IgAN, FSGS, and LN.
Collapse
Affiliation(s)
- Tripti Singh
- Division of Nephrology, Departments of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Brad Astor
- Division of Nephrology, Departments of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Weixiong Zhong
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Didier Mandelbrot
- Division of Nephrology, Departments of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Arjang Djamali
- Division of Nephrology, Departments of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sarah Panzer
- Division of Nephrology, Departments of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|