Introduction:
Immunoglobulin A Nephropathy (IgAN) patients are significantly more likely to undergo renal transplant, performed at a younger age, and have lower post-transplant mortality rates than the overall ESRD population. In 9–61% of individuals, IgAN may recur in the renal allograft. It was believed that recurrent illness would not significantly affect graft results. However, more recent retrospective studies with longer follow-up periods indicate that disease recurrence significantly increases the risk of allograft deterioration. When compared to non-crescentic IgAN recurrence following transplantation, crescentic IgAN after transplantation results in worse allograft outcomes. There are sparse individual case reports of post-transplant crescentic IgA from Indian sub-continent. We are presenting a case series of 5 patients with intention to treat approach and their outcomes providing further insight to this infrequent yet crucial event.
Methods:
5 patients with different age group who underwent renal transplant at different timeline presented with graft dysfunction in the form of protenuria or rising serum creatinine or both. 4 out of 5 patients were male. Mean duration of transplantation was 7.5 years. Mean age at the time of presentation was 42.4 years. Mean serum creatinine was 3.28 with UPCR of 4.9 g/g They all underwent graft renal biopsy by standard techniques.
Results:
All patient received three to five IV pulse steroids and cyclical IV Cyclophosphamide for 2-5 months, patients were closely followed up. Mean duration of follow-up was 7.4months. Mean serum creatinine was 3.9mg/dl and mean UPCR was 2.9gm/gm. 2 patients had undergone graft loss and was started on maintenance hemodialysis. Unfortunately, one patient succumbed to infectious illness and died with functioning graft. Death censored graft survival was 60%.
Conclusions:
Our findings support the hypothesis that crescentic IgAN represents a more severe and aggressive form of disease, and thus, resulting in reduced graft life and early progression to ESRD. Our study identifies that there is a lacuna in treatment of these events which needs to be addressed and requires more aggressive intervention in the form of IV cyclophosphamide or pulse steroids or even plasmaphresis in selected patients to prolong the graft survival. Role of novel agents are yet to be determined in this scenario.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.