Recurrence of immunoglobulin A nephropathy after renal transplantation in the cyclosporine era
| Autor: | Christian Hiesse, D. Hestin, Michèle Kessler, Daniel Mayeux, Karim Boubenider, Bernard Charpentier |
|---|---|
| Rok vydání: | 1996 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors IgA Vasculitis Urinary system urologic and male genital diseases Kidney Gastroenterology Nephropathy chemistry.chemical_compound Recurrence Internal medicine Biopsy medicine Humans Retrospective Studies Creatinine medicine.diagnostic_test business.industry Incidence Graft Survival Glomerulonephritis Glomerulonephritis IGA medicine.disease Kidney Transplantation Surgery Transplantation medicine.anatomical_structure chemistry Nephrology Case-Control Studies Cyclosporine Female business Complication Immunosuppressive Agents Follow-Up Studies |
| Zdroj: | American journal of kidney diseases : the official journal of the National Kidney Foundation. 28(1) |
| ISSN: | 0272-6386 |
| Popis: | Immunoglobulin A nephropathy (IgAN) frequently recurs in patients after renal transplantation (RT) on a conventional regimen of immunosuppressive therapy, but little is known about the influence of cyclosporine (Cs) on such a recurrence. We studied 84 patients retrospectively who underwent RT for renal failure attributable to IgAN (n = 71) or Henoch-Schonlein purpura nephropathy (HSPN) (n = 13) in two transplantation units, between January 1985 and June 1991 and were treated with Cs. Four patients died 3 months to 8 years after RT. Graft survival was 88% at 1 year, 75.2% at 5 years, and 63% at 8 years. Fifty patients underwent at least one graft biopsy, but studies with immunofluorescence were performed on only 28 (23 IgAN and 5 HSPN). After a mean follow-up of 68.1 +/- 37.2 months, mesangial IgA deposits recurred in 13 of the 28 patients (12 IgAN and 1 HSP) (prevalence, 46.4%). Among the 13 patients with recurrence of IgA deposits, all but 4 had urinary abnormalities. Light microscopy showed mesangial deposits and focal and segmental glomerular changes in 9 cases. Four patients lost their graft function 69 to 119 months after RT, and 2 had severe graft dysfunction. The rates of graft failure and mean serum creatinine at 1, 5, and 8 years were similar in the 13 patients with recurrence and the 15 patients without proven recurrence. In conclusion, Cs did not reduce the incidence or severity of IgAN recurrence. The latter was the cause of graft loss or dysfunction in 46.1 % of the patients with recurrent IgA deposits. Recurrent glomerulonephritis did not influence the 8-year graft survival in patients with IgAN or HSPN, but it may be an important cause of graft loss as evidenced by more extended follow-up. |
| Databáze: | OpenAIRE |
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