Favorable outcome of renal transplantation in patients with IgA nephropathy

Background: The outcome of renal transplantation in patients with IgA nephr opathy (IgAN) may be affected by recurrence of the original disease. Despit e this risk of recurrent glomerulonephritis, graft survival in patients wit h IgAN is considered good although formal comparisons with graft survival i n patients with other renal diseases have given conflicting results. Method s: We have studied both recurrence rate and outcome after renal transplanta tion in 79 adult patients with IgAN, all of whom received a first renal gra ft (55 cadaveric, 24 living-related donor) in our center in the period betw een 1969 and 1997. Graft survival in patients with IgAN was compared with t he outcome in patients with pyelonephritis and adult polycystic kidney dise ase (group 2) and patients with non-IgA primary glomerulonephritis (group 3 ). Results: Follow-up averaged 5.6 +/- 4.5 years. Histological evidence of mesangial IgA deposits was present in 17 of 32 available biopsies (53%). Cl inically recurrent IgAN was diagnosed only in 7 patients (9% of all recipie nts), with a higher incidence in recipients of a living-related donor graft (5/24 (20%) vs 2/55 (4%)). These recurrences were diagnosed in biopsies ta ken 13 - 145 months after transplantation; and all were characterized by si gnificant proteinuria (> 1 g/day). In only one patient the graft was lost d ue to the recurrence. For recipients of a cadaveric, graft, the 5-year graf t survival was significantly better in IgAN patients than in both reference groups (86% vs 67% in group 2; p = 0.012, and 60% in group 3; p = 0.007). This difference remained significant after censoring for death. There was n o statistically significant difference in the patient survival between the groups. The rejection rate in the first 3 months was numerically lower in t he IgAN patients (37% vs 43% and 49%, respectively), and total immunologica l failure rate was also lower in the IgAN patients compared to the control groups (13% vs 21% and 23%, respectively); although the differences were no t statistically significant. The 5- and 10-year graft survival in recipient s of living-related donor grafts was significantly better in IgAN patients than in group 3 (96% and 84% vs 64% and 21%, respectively; p = 0.02), but s imilar to graft survival in group 2 (87% and 75%). Conclusion: A clinical r ecurrence of IgAN occurred in 4% of patients with a cadaveric donor graft a nd 20% of patients with a living-related donor graft. The recurrence had ne gligible influence on 5- and 10-year graft survival. Graft survival after c adaveric transplantation was better in the IgAN patients compared to contro l groups; possibly due to the lower immunological failure rate in IgAN.