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Prognostic factors associated with poor graft outcomes in renal recipients with post‐transplant glomerulonephritis
Author(s) -
RequiãoMoura Lúcio R,
MoscosoSolorzano Grace T,
Franco Marcello F,
Ozaki Kikumi S,
PachecoSilva Alvaro,
Kirsztajn Gianna Mastroianni,
Câmara Niels O.S.
Publication year - 2007
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/j.1399-0012.2007.00650.x
Subject(s) - medicine , proteinuria , gastroenterology , glomerulonephritis , transplantation , population , kidney disease , creatinine , hemodialysis , kidney transplantation , focal segmental glomerulosclerosis , urology , kidney , surgery , environmental health
Background: Little data are available concerning post‐transplantation glomerulonephritis (PTx‐GN) and its prognostic factors associated with graft outcomes. Methods: We retrospectively evaluated patients with de novo and recurrent PTx‐GN to identify the factors associated with their negative impact on graft and patient outcomes. PTx‐GN was diagnosed in 55 patients, wherein 17 (31%) had recurrent glomerulonephritis (GN) and 16 (29%) had de novo . Results: Our enrolled population consisted of 34 ± 13.7‐yr‐old male patients (72%), on hemodialysis for a median of 18 months (0–204) and mainly grafted from living donors (76%). The median onset time of proteinuria and hematuria was 50 d (10–2160) and 30 d (4–1170), respectively. One‐yr graft survival rates after PTx‐GN diagnosis was 64%. The most frequent de novo GN was membranous GN (26%), while focal segmental glomerulosclerosis was the most frequent recurrent GN (41%), with a very early onset (median of three months). One‐yr graft survival was better in the recurrent disease than in the de novo patients, 76% vs. 55% (p = 0.24). The best predictor factors that correlated with graft survival were: proteinuria <3.5 g [relative risk (RR) = 0.24, p = 0.017], serum creatinine below 2.0 mg/dL (RR = 0.06, p = 0.016) at the time of biopsy and the use of angiotensin‐converting enzyme inhibitors (ACEI) (RR = 0.12, p = 0.005). The use of ACEI markedly improved one‐yr graft survival rates (92% vs. 47%, p < 0.001). Conclusion: PTx‐GN has a strong negative impact on kidney graft survival. De novo GN appears to have a poorer prognosis than the recurrent type. Patients who used ACEI showed a better survival rate in the follow‐up.