Live donor renal allograft in end-stage renal failure patients from immunoglobulin a nephropathy

Background The purpose of this study was to attempt to resolve two importan t issues, i.e. to determine (1) whether the course of recurrent immunoglobu lin A nephropathy (IgAN) is benign, and (2) whether it is advisable to use a related donor. Methods. We evaluated the long-term outcome, in terms of recurrence and gra ft survival, after live related or unrelated donor renal transplantation, a nd assessed the validity of the use of related donors in 90 grafts in 89 Ig AN patients. Results. Ten-year graft survival for fg AN patients was 66%, compared with 84% for 107 reference recipients who had other kinds of glomerulonephritis (GN), and with 69% in 90 other recipients who had non-GN renal failure (P=0 .27). In 43 grafts, 54 event graft biopsies were performed, documenting the presence of mesangial IgA deposits in 19 of those grafts. In eight grafts, lesions were accompanied by chronic rejection (CR). Ten-year cumulative re currence was 44%. Ten grafts were lost: by CR (n=3) or acute rejection (n=1 ) in 24 recurrence-free recipients, by CR (n=2) or recurrence (n=2) in 19 r ecurrent patients, and by patient death (n=2) in 46 patients devoid of graf t biopsy. We found no difference in 10-year graft survival between the recu rrent and recurrence-free patients (63% vs. 74%, P=0.98), or the proportion of related donors (68% vs. 83%, P=0.25). The presence or matching of HLA B 12, B35, or DR4 did not affect the recurrence. Conclusions. Recurrence increased to 44% with longer follow-up, but this di d not limit the graft outcome. Recurrence was not affected by the kind of l ive donor. We conclude that live related or unrelated kidneys should be off ered to IgAN patients.