POST RENAL TRANSPLANT IMMUNOGLOBULIN A (IGA) NEPHROPATHY - NEED TO LOOK DEEPER !

Introduction:

Recurrent Glomerulonephritis post renal transplantation is the third most common cause of allograft dysfunction and allograft loss. The incidence and risk factors associated with recurrence of IgA nephropathy are unclear, especially in the Indian population. We evaluated the incidence and possible risk factors of post renal transplant IgA nephropathy. 

Methods:

Our multicenter, retrospective observational study analyzed 782 transplant recipients conducted by four nephrologists in Mumbai. 236 post transplant kidney biopsies were done in these patients who had undergone kidney transplants from 2007 to 2024. The data of 21 kidney transplant recipients with biopsy proven IgA nephropathy was retrieved from AXIS (our renal database and software). Incidence and risk factors of recurrent IgA nephropathy and allograft loss were studied. 

Results:

GRAFTV

Out of 236 kidney transplant recipient biopsies done, 21 had IgA nephropathy on kidney biopsy. The median age at transplant was 34 Years. The median duration of IgA nephropathy proven on kidney biopsy was 92 months (7.6 years) post transplant. 4, 17 and 21 patients had recurrent IgA nephropathy at 5, 10 and 15 years respectively post transplant. The 1, 3, 5, 10 and 15 year graft survival of these patients was 100%, 100%, 90.5%, 85.7% and 80.9% respectively. The 1, 3, 5, 10 and 15 year patient survival of these patients was 100%, 100%, 100%, 95.2% and 85.7% respectively. The indication for the post transplant biopsy was graft dysfunction +/- proteinuria in 81% and proteinuria +/- microscopic hematuria in 19% patients. Proteinuria at the time of biopsy was > 300 mg/dL (3+ and above) for 28.57% patients. The Oxford MEST score was <3 in 52.38% patients and equal to or >3 in 47.62% patients. 23.8% of the patient’s biopsies showed acute or chronic cell mediated rejection in addition to IgA nephropathy on biopsy. 4.7 % biopsies showed combined cell mediated and antibody mediated rejection along with IgA nephropathy. 4 patients out of 21 (19.05%) had allograft loss and 2 patients underwent a second transplantation post IgA nephropathy recurrence. The Oxford MEST score in all the patients who had allograft loss was found to be 3. Out of the patients who lost their allograft, 2 out of 4 (50%) were found to have concurrent active cell mediated rejection proven on biopsy. In the patients who lost their allografts, the mean allograft survival was 6.5 years. 

Conclusions:

Post Transplant recurrence of IgA nephropathy is associated with allograft dysfunction and allograft loss. Concurrent Cell mediated rejection is found to have poorer outcomes. Oxford MEST score was found to be higher in the patients who suffered allograft loss compared to the others. Proteinuria was not found to be predictive for allograft loss.  

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.