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Recurrent IgA nephropathy after renal transplantation and steroid withdrawal
Author(s) -
Di Vico Maria Cristina,
Messina Maria,
Fop Fabrizio,
Barreca Antonella,
Segoloni Giuseppe Paolo,
Biancone Luigi
Publication year - 2018
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.13207
Subject(s) - medicine , tacrolimus , azathioprine , transplantation , gastroenterology , kidney transplantation , nephropathy , urology , mycophenolate , glomerulonephritis , kidney , immunosuppression , renal biopsy , biopsy , mycophenolic acid , corticosteroid , surgery , endocrinology , disease , diabetes mellitus
Abstract Immunoglobulin A nephropathy (Ig AN ) is the most common primary glomerulonephritis; the reported recurrence rate of Ig AN after renal transplantation is as high as 13%‐50%. The impact of immunosuppressive therapy and steroid withdrawal on the risk of recurrence of Ig AN is still under debate. We performed a retrospective single‐center study, selecting 123 kidney transplants (rtx) in 120 patients, between January 1995 and December 2012, with Ig AN on the native kidney. In 51 of 123 transplants, at least one post‐transplantation biopsy for clinical indication was performed; in 28 of 51 transplants, Ig AN recurrence (Ig AN r) was demonstrated. This group (G1; N = 28) was compared with a group without Ig AN r (G2; N = 23). In our study, clinically evident Ig AN r rate was 54.9% (28/51) on biopsied patients. At discharge, the use of the immunosuppressant drugs (tacrolimus, cyclosporine A, mycophenolate mofetil, azathioprine, mT or inhibitors) was not associated with an increased risk of Ig AN r ( P = NS ). At discharge, all patients were steroid treated. Neither the use of tacrolimus, mycophenolate mofetil, nor mT or inhibitors ( mT ori) at biopsy time were associated with Ig AN r. However, Ig AN r was significantly higher in patients who experienced steroid withdrawal at any post‐transplantation time ( OR 7.7 P = .03). The median time to recurrence after steroid withdrawal was 59 months (min 4.18, max 113.2).