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The risk of recurrent I g A nephropathy in a steroid‐free protocol and other modifying immunosuppression
Author(s) -
Von Visger J. R.,
Gunay Y.,
Andreoni K. A.,
Bhatt U. Y.,
Nori U. S.,
Pesavento T. E.,
Elkhammas E. A.,
Winters H. A.,
Nadasdy T.,
Singh N.
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12389
Subject(s) - immunosuppression , medicine , hazard ratio , nephropathy , kidney transplantation , kidney disease , kidney , gastroenterology , glomerulonephritis , transplantation , immunology , urology , endocrinology , diabetes mellitus , confidence interval
Recurrent glomerulonephritis is an important cause of kidney allograft failure. The effect of immunosuppression on recurrent IgA nephropathy (Ig AN ) is unclear. We analyzed the impact of steroids and other immunosuppression on the risk of recurrent Ig AN post‐kidney transplantation. Between June 1989 and November 2008, 3311 kidney transplants were performed at our center. Ig AN was the primary disease in 124 patients; of these, 75 (60.5%) patients received steroid‐based immunosuppression (15 undergoing late steroid withdrawal), and 49 (39.5%) were maintained on steroid‐free immunosuppression. Recurrent Ig AN was diagnosed in 27 of 124 (22%) patients in clinically indicated kidney allograft biopsies over a median follow‐up of 6.86 ± 5.4 yr. On cox proportional hazards model multivariate analysis, the hazard risk ( HR ) of Ig AN recurrence was significantly higher in patients managed with steroid‐free ( HR 8.59: 3.03, 24.38, p < 0.001) and sirolimus‐based ( HR = 3.00:1.16, 7.75, p = 0.024) immunosuppression without antilymphocyte globulin induction ( HR = 4.5: 1.77, 11.73, p = 0.002). Mycophenolate use was associated with a lower risk ( HR = 0.42: 0.19, 0.95, p = 0.036), whereas cyclosporine did not have a significant impact on the risk of Ig AN recurrence (p = 0.61). These results warrant future prospective studies regarding the role of steroids and other immunosuppression drugs in reducing recurrence of Ig AN and other glomerulonephritis post‐transplant.