THE INFLUENCE OF NATIVE NEPHRECTOMY ON THE INCIDENCE OF RECURRENT DISEASE FOLLOWING RENAL-TRANSPLANTATION FOR PRIMARY GLOMERULONEPHRITIS

Factors influencing the incidence of recurrent glomerulonephritis foll owing renal transplantation are poorly understood, Bilateral pretransp lant native nephrectomy has been advocated to reduce the likelihood of recurrence after renal transplant, However, there is significant morb idity of native nephrectomy in the uremic population, Therefore, we so ught to determine the effect of pretransplant native nephrectomy on th e incidence of recurrent primary glomerulonephritis and the attendant risk of graft failure due to recurrent disease, Three hundred sixty-fo ur consecutive cadaveric (n=214), living-related (n=137), and living-u nrelated (n=13) renal transplants were performed in 319 patients with a diagnosis of primary glomerulonephritis. Specific diagnoses included were focal segmental glomerulosclerosis (FSGS), rapidly progressive g lomerulonephritis/idiopathic crescentic glomerulonephritis (RPGN/ICG), IgA nephropathy (IgA), mesangioproliferative glomerulonephritis, type I and II (MPG), anti-glomerular basement membrane nephritis (anti-GBM ), and membranous glomerulonephritis (MGN). Rates of recurrence and gr aft loss were compared between patients treated with bilateral native nephrectomy (n=61) and those who were not (n=303). Bilateral nephrecto my did not prevent or delay the onset of recurrent glomerulonephritis in the renal allograft. In fact, there was a significantly increased f ive- and ten-year risk of recurrence in patients undergoing pretranspl ant nephrectomy vs, no nephrectomy (25.2% and 42% vs, 13.9% and 19.4%, P<0.02, respectively), The increased rate of recurrence was evident i n the CAD/LUD recipients, but not in recipients of LRD transplants, Of the specific diseases, FSGS and MGN recurred more commonly (20.2% and 20.3%, respectively), A detrimental effect of pretransplant nephrecto my on recurrence rates and incidence of graft loss due to recurrent di sease independent of other variables could be demonstrated only for FS GS patients, Based on these findings, we no longer recommend native ne phrectomy in the prospective renal transplant recipient at high risk f or developing recurrent glomerulonephritis.