Kidney transplantation in patients with IgA mesangial glomerulonephritis

Background. Strategies for treating IgA glomerulonephritis (IgAGN) are cont roversial, particularly with regards to the longterm results of kidney tran splantation, including the risk of recurrence of IgAGN post-transplant and the impact of this recurrence on graft survival. Methods. The outcomes of 106 adults transplanted because of a biopsy-proven IgAGN and of 212 patients without IgAGN transplanted during the same perio d were analyzed. To evaluate the risk of recurrence, patients with hematuri a, proteinuria, or an increase in plasma creatinine were submitted to allog raft biopsy. Factors influencing recurrence and the impact of recurrence on graft survival were analyzed. Results. The ten-year patient (0.93 vs. 0.92) and graft survival (0.75 vs. 0.82) probabilities were not significantly different between IgAGN patients and controls. Only plasma creatinine and proteinuria at six months were as sociated with an increased relative risk (RR) of graft failure (RR 2.79 and 5.94, respectively). Histological recurrence of IgA glomerulonephritis was diagnosed in 37 patients. Younger age (RR 2.63), increased plasma creatini ne (RR 2.39), and proteinuria (RR 6.02) at six months were associated with the risk of recurrence. If proteinuria and plasma creatinine at six months were considered in the Cox model, IgA recurrence per se was not associated with an increased risk of graft failure (P = 0.181). The main causes of gra ft failure were glomerulonephritis in patients with recurrence of IgAGN and chronic rejection in patients without recurrence. Conclusions. The ten-year graft survival rate was similar in patients with IgAGN or other renal diseases. At least 35% IgAGN patients had biopsy-prove n recurrence, and younger patients were more prone to the risk of recurrenc e. Recurrence did not affect the ten-year graft survival.