1
|
Rodas LM, Ruiz-Ortiz E, Garcia-Herrera A, Pereira A, Blasco M, Ventura-Aguiar P, Viñas Gomis O, Egri N, De Sousa E, Palou E, Diekmann F, Poch E, Campistol JM, Quintana LF. IgA Nephropathy Recurrence after Kidney Transplantation: Role of Recipient Age and Human Leukocyte Antigen-B Mismatch. Am J Nephrol 2020; 51:357-365. [PMID: 32187607 DOI: 10.1159/000506853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recurrence of immunoglobulin (Ig)A nephropathy (rIgAN) is a growing cause of kidney allograft dysfunction. This study was aimed at investigating factors associated with rIgAN and the subsequent progression to end-stage renal disease (ESRD). METHODS Retrospective study including consecutive patients with IgA nephropathy (IgAN) who received a kidney transplant in our center between 1992 and 2016 and had a renal biopsy by clinical indication. The date of detection of chronic kidney disease (CKD) 5 was used as renal outcome. RESULTS Eighty-six kidney transplants were performed in patients with IgAN, 38 (44%) were from living donors (related n = 26). rIgAN was diagnosed in 23 allografts (27%). Renal function and proteinuria at the end of the follow-up period were worst in the rIgAN patients compared to those without rIgAN (2.2 vs. 1.4 mg/dL, p = 0.014, and 1.16 vs. 0.49 g/day, p = 0.005, respectively). Risk of rIgAN and progression to CKD 5 decreased with patient's age (hazard ratio [HR] 0.95, 95% CI 0.92-0.98, p = 0.002, and HR 0.97, 95% CI 0.83-0.97, p = 0.008 per year, respectively). Patients with rIgAN had a higher risk of progression to CKD 5 (HR 6.7, 95% CI 1.3-35.7, p = 0.025). Full donor-recipient mismatch in the human leukocyte antigen (HLA)-B loci decreased the risk of rIgAN (HR 0.22, 95% CI 0.06-0.76, p = 0.017). CONCLUSIONS rIgAN was an independent risk factor for ESRD after renal allograft. Younger age increased the risk of rIgAN and CKD 5. Conversely, HLA-B mismatching was a potential protective factor for rIgAN of this glomerular disease.
Collapse
Affiliation(s)
- Lida M Rodas
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain,
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain,
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain,
| | | | - Adriana Garcia-Herrera
- Department of Pathology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
| | - Arturo Pereira
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Miquel Blasco
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | | | - Natalia Egri
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | - Erika De Sousa
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Eduard Palou
- Department of Immunology, Hospital Clínic, Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Esteban Poch
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Josep M Campistol
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Luis Fernando Quintana
- Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| |
Collapse
|