Clinical Predictors and Prognosis of Recurrent IgA Nephropathy in the Kidney Allograft.

Autor:	Kavanagh CR; Pediatric, Nephrology, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital, New York, NY, USA., Zanoni F; Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY, USA., Leal R; Nephrology department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.; Faculty of Medicine, University of Coimbra, Portugal., Jain NG; Pediatric, Nephrology, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital, New York, NY, USA., Stack MN; Medicine, Nephrology, Oregon Health & Science University, Portland, OR, USA., Vasilescu ER; Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA., Serban G; Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA., Shaut C; Medicine, Nephrology, Oregon Health & Science University, Portland, OR, USA., Kamal J; Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY, USA., Kudose S; Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA., Martinho A; Centro de Histocompatibilidade do Centro, Instituto Português do Sangue da Transplantação, Coimbra, Portugal., Alves R; Nephrology department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.; Faculty of Medicine, University of Coimbra, Portugal., Santoriello D; Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA., Canetta PA; Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY, USA., Cohen D; Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY, USA., Radhakrishnan J; Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY, USA., Appel GB; Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY, USA., Stokes MB; Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA., Markowitz GS; Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA., D'Agati VD; Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA., Kiryluk K; Faculty of Medicine, University of Coimbra, Portugal., Andeen NK; Pathology, Oregon Health & Science University, Portland, OR, USA., Batal I; Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA.
Jazyk:	angličtina
Zdroj:	Glomerular diseases [Glomerular Dis] 2022 Jan; Vol. 2 (1), pp. 42-53. Date of Electronic Publication: 2021 Sep 24.
DOI:	10.1159/000519834
Abstrakt:	Introduction: Although IgA nephropathy (IgAN) is the most common recurrent glomerulonephritis encountered in the kidney allograft, the clinical and immunogenetic characteristics remain poorly understood. We sought to study determinants and prognosis of recurrent IgAN with special focus on HLA antigens. Materials and Methods: Between 2005 and 2019, we identified 282 transplanted patients with failure secondary to IgAN from two North American and one European Medical Centers, including 80 with recurrent IgAN and 202 without recurrence. Prevalence of HLA antigens was compared to external healthy controls of European ancestry (n=15,740). Graft survival was assessed by Kaplan-Meier method and log rank test. Cox proportional hazards were used for multivariable analyses. Results: Compared to external controls of European ancestry, kidney transplant recipients of European ancestry with kidney failure secondary to IgAN had higher frequency of HLA-DQ5 (42% vs. 30%, OR=1.68, P=0.002) and lower frequency of HLA-DR15 (15% vs. 28%, OR=0.46, P<0.001) and HLA-DQ6 (32% vs. 45%, OR=0.59, P=0.003); however, the frequency of these HLA antigens were similar in recurrent versus non-recurring IgAN. Younger recipient age at transplantation was an independent predictor of recurrence. HLA-matching was an independent predictor for recurrent IgAN only in recipients of living-related but not deceased or living unrelated transplants. Recurrent IgAN was an independent predictor of allograft failure, along with acute rejection. In patients with recurrent IgAN, serum creatinine at biopsy, degree of proteinuria, and concurrent acute rejection were associated with inferior allograft survival. Discussion/ Conclusion: Recurrent IgAN negatively affects allograft survival. Younger recipient age at transplantation is an independent predictor of recurrent IgAN, while the presence of HLA antigens associated with IgAN in the native kidney and HLA-matching in recipients of deceased or living unrelated transplants are not. Competing Interests: Disclosure: The authors declare no conflicts of interest
Databáze:	MEDLINE
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