GLOMERULONEPHRITIS AFTER RENAL TRANSPLATA TION - MADRID-TRASPLANTE EXPERIENCE

We report results over 30 years in patients developping glomerulonephr itis (GN) after renal transplantation from the Madrid-Trasplante Group , integrated by Clinica Puerta de Hierro (CPH), Fundacion Jimenez Diaz (FJD), Hospital General Universitario Gregorio Maranon Adultos (HGU G M A) and Infantil (HGU GM I). The prevalence rate of GN was 1.93% in 1 ,610 renal grafts involving 28 patients, 22 males and 6 females, with 31 kidney graft, 29 from cadaver and 2 from living related donnos. The patient ranged in age from 4 to 53 (mean age, 26 +/- 2 years) (Tablel ). The underlying renal diseases are displayed in Table II and III. Me mbranous, Focal sclerosing and IgA GN were the most common histologic diagnosis. Documented histologic recurrence ocurred in only 1% of pati ents with prior biopsy proven glomerulonephritis of their native kidne y. Patients with FSGN had the gratest risk for recurrence. De novo GN account for 14, from wich, 11 were membranous GN, 2 IgA GN and 1 Schon lein-Henoch Purpura. Recurrent GN accounts for 17, two were membranous GN, 8 were FSGN, two were IgA GN, 3 were membranoproliferative GN, on e was Goodpasture Syndrome and one Dependent Insulin Diabetes Mellitus . Inmunossupression was done with prednisone, azathioprine and Cyclosp orine A. In the early post-transplant period, mono and polyclonal anti bodies were utilized. Only 12 grafts are functioning now (Table IV). R ecurrent GN was the main cause of graft failure, 13 grafts were lost, two of them with normal renal function. The follow up ranged from 36 t o 96 months. Proteinuria onset from 1 to 2,346 days after transplantat ion. Basal creatinine value was 1.7 mg/dl, as shown Table V. Treatment with plasmapheresis and inmunoadsorption was done, without good resul ts. The patient survival is 80% at 96 months and graft survival is 30% at 96 months (figure 1 and 2). The grafts were lost in the first 3 ye ars after transplantation. We conclude that de novo membranous GN is t he most frequent, and has good prognosis. FSGN and MPGNI recurr most f requent.