SINGLE-CENTER LONG-TERM RESULTS OF RENAL-TRANSPLANTATION FOR IGA NEPHROPATHY

Background. Previous reports with short-term follow-up after renal tra nsplantation for IgA nephropathy (IgAN) have suggested an incidence of recurrence up to 50%, an increased recurrence with living-related don ors, and the rarity of graft loss due to recurrence. In this study, th e long-term results of renal transplantation for IgAN were examined. M ethods. Between June 1980 and December 1994, 54 patients (61 renal tra nsplants) with end-stage renal disease due to IgA nephropathy were per formed at the University of California San Francisco. Actuarial patien t and graft survival were compared with a matched reference group. Cor relates of recurrent disease (biopsy confirmed and graft loss were det ermined. Results. Patient and graft survival for IgA patients were goo d (100% and 75%, respectively, at 5 years after transplant). Graft sur vival was lower in IgA recipients with living-related compared with ca daveric renal allografts (P<0.09) and also with renal allografts well matched at HLA-AB (less than or equal to 2 AB mismatches) (P<0.09) or HLA-DR (less than or equal to 1 mismatch) (P<0.01). Recurrence was not correlated with donor status, recipient age, race, gender, or immunos uppression. Recurrence (18 of 61) resulted in substantial graft loss ( 6 of 18) or deteriorating renal function (4 of 18) at a mean follow-up of 61 months. Mean time to diagnosis of recurrence and subsequent gra ft loss was 31 and 63 months, respectively. Despite re-recurrence of I gAN in three of five patients who were retransplanted, all have good l ong-term renal function. Conclusions. Substantial graft loss due to re current disease after renal transplantation for IgAN occurs with long- term follow-up. Living-related transplantation and HLA matching do not appear to confer an advantage for graft survival in patients with IgA N. Despite the potential for recurrence, IgAN patients enjoy good long -term graft survival.