H-Index
34
Scimago Lab
powered by Scopus
JCR
Clarivate
Analytics
call: +1.631.629.4327
Mon-Fri 10 am - 2 pm EST

Logo



eISSN: 2329-0358

Get your full text copy in PDF

Clinical Features, Treatment and Prognostic Factors of Post-Transplant Immunoglobulin A Nephropathy

Diogo Buarque Cordeiro Cabral, Tainá Veras de Sandes-Freitas, José Osmar Medina-Pestana, Gianna Mastroianni-Kirsztajn

(Glomerulopathies Section (Nephrology Division), Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil)

Ann Transplant 2018; 23:166-175

DOI: 10.12659/AOT.907167


BACKGROUND: Initially described as a relatively benign condition, recent studies report graft loss in up to 50% of the patients with post-transplant IgA nephropathy. There is no evidence for the best therapeutic approach, and prognostic factors remain to be elucidated.
MATERIAL AND METHODS: Single center retrospective analysis of patients >12 years old, with clinically relevant post-transplant IgA nephropathy (proteinuria ≥1.0 g/g and/or graft dysfunction) and ≥6 months follow-up after diagnosis (n=47).
RESULTS: Living donor transplants represented 85% of cases. Dysmorphic hematuria (100%), blood pressure elevation (95.7%), renal dysfunction (70.2%) and subnephrotic proteinuria (60.6%) predominated at presentation. Using the Oxford Classification, mesangial proliferation was the main histological lesion (91%). Treatment consisted mostly of blockade of the renin angiotensin system (89.4%) and modification of immunosuppression (85.1%), mainly by increasing oral steroids dose (83%), with venous pulse therapy in 63.8% of cases. Partial and complete remission occurred in 48.9% and 17% of cases, respectively. One patient died (sepsis) and 15 patients (31.9%) lost their grafts due to nephropathy. The percentage of decrease in glomerular filtration rate at diagnosis was independently associated with partial remission (HR 0.97, 95% CI 0.94–0.99, p=0.01) and graft loss (HR 1.13, 95% CI 1.06–1.20, p<0.001). Deceased donor (HR 28.04, 95% CI 4.41–178.39, p<0.001) and donor age (HR 1.1, 95% CI 1.04–1.16, p=0.001) were also risk factors for graft loss.
CONCLUSIONS: Despite treatment, most patients with post-transplant IgA nephropathy in this cohort study presented unfavorable outcomes, and graft dysfunction at diagnosis appeared to be the main prognostic marker.

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
I agree