THE FATE OF RENAL-TRANSPLANTS IN PATIENTS WITH IGA NEPHROPATHY

Background. IEA Nephropathy (IgA N) is one of the most common glomerul opathies and may lead to renal failure in 10-20% of cases. After renal transplantation, IgA N has a strong tendency to recur in the graft. I nitially considered a benign condition, graft losses from recurrent Ig A N have been reported over the last 20 yr, casting doubt on the initi al premise. Since large single-center studies of the fate of renal all ografts in IgA N are rare and the Mayo Clinic transplant experience fo r IgA N is extensive (dating back to 1970), a review of these issues a ppeared worthwhile. Methods. A retrospective study was done of all ren al transplant patients who had had biopsy-proven IgA N as underlying d isorder. We extracted data on the underlying disease, history leading to renal transplantation, factors affecting transplant outcome, and on the course after transplantation with special attention to rejection activity and recurrence of the primary disease. Standard statistical m ethods were employed. Results. 53 renal allografts were transplanted t o 51 biopsy-proven IgA N patients: 12 were cadaveric (CAD) grafts, 3 H LA-mismatched living related donor (LRD) kidneys, 29 one haplotype-mat ched LRD and 9 HLA-identical LRD organs. Five-year actuarial graft sur vival was 100% in HLA-identical LRD, 88% in one haplotype-matched LRD, and 74% in CAD grafts. All three HLA-mismatched LRD kidneys were func tioning up to 1.6 yr (longest follow-up). Only one patient died after acute rejection of the CAD graft. There were 3 early graft losses from acute rejection and 4 late losses. IgA N recurred in 26% of allograft s and led to significant loss of graft function in 10 of the 14 patien ts (71%) over a long period of observation. Three of four late graft l osses were in patients with recurrent IgA N. Recurrence was not relate d to the type of graft, i.e. CAD vs. LRD, nor to the extent of HLA-mat ching in LRD transplantation. Conclusion. Renal transplantation in pat ients with IgA N has excellent patient and graft survival. There is a high rate of recurrence of the primary glomerulopathy in the renal all ograft, and this event is by no means inconsequential. Loss of renal f unction and even graft loss occur over prolonged periods of time. Ther e is no disadvantage getting a well matched LRD in regard to incidence of recurrent IgA N. Thus, we encourage LRD transplantation in IgA N.