Ortiz Fernanda, Gelpi Rosana, Koskinen Petri, Manonelles Anna, Räisänen-Sokolowski Anne, Carrera Marta, Honkanen Eero, Grinyó Josep M, Cruzado Josep M
Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland.
Nephrol Dial Transplant. 2012 Jun;27(6):2553-8. doi: 10.1093/ndt/gfr664. Epub 2011 Dec 13.
The recurrence of IgA nephropathy (IgAN) in the allograft is common. Factors related to IgA recurrence are unclear. The aims of this study were to determine the incidence of IgAN recurrence as assessed by protocol biopsies and to identify predictive factors for recurrence.
We identified 65 protocol biopsies taken before the second year post-transplantation in patients with IgAN as primary renal disease. Diagnosis of recurrence of IgA was based on the detection of at least 1+ mesangial deposits of IgA. Pathological findings and clinical characteristics were retrospectively compared between recurrent and non-recurrent cases.
IgAN recurrence rate was 32%. Mesangial C3 was detected in 83% of recurrent cases versus 17% in non-recurrent patients (P < 0.001). Normal urinalysis was observed in 52%. Non-recurrent patients had arteriolar hyalinosis in 31% of the cases versus none in IgAN recurrence (P = 0.006). Seventy-nine per cent of cyclosporine users were free of recurrence, whereas 45% of the patients without cyclosporine experienced recurrence (P = 0.03). The odds ratio (OR) for IgAN recurrence in patients using cyclosporine was 0.3 (confidence interval 0.1-0.9). Zero HLA-DR mismatch was associated with non-recurrence (P < 0.01). The OR for IgA recurrence was 6.7 if any degree of DR mismatch was present. IgAN recurrent patients had better glomerular filtration rate, but after censoring delayed graft function, the differences disappeared. Graft loss due to IgA recurrence was only 3%.
IgAN recurrence rate was 32%. The histological diagnosis was not accompanied by abnormalities in the urinalysis in one-half of the patients. Full DR match and cyclosporine were associated with non-recurrence.
移植肾中IgA肾病（IgAN）复发很常见。与IgA复发相关的因素尚不清楚。本研究的目的是通过方案活检确定IgAN复发的发生率，并确定复发的预测因素。
我们确定了65例以IgAN作为原发性肾病的患者在移植后第二年之前进行的方案活检。IgA复发的诊断基于检测到至少1+的IgA系膜沉积物。对复发和未复发病例的病理结果和临床特征进行回顾性比较。
IgAN复发率为32%。83%的复发病例检测到系膜C3，而非复发患者中这一比例为17%（P<0.001）。52%的患者尿常规正常。31%的非复发患者有小动脉玻璃样变，而IgAN复发患者中无一例出现（P = 0.006）。79%使用环孢素的患者未复发，而未使用环孢素的患者中有45%复发（P = 0.03）。使用环孢素的患者中IgAN复发的比值比（OR）为0.3（置信区间0.1 - 0.9）。零HLA - DR错配与未复发相关（P<0.01）。如果存在任何程度的DR错配，IgA复发的OR为6.7。IgAN复发患者的肾小球滤过率较好，但在排除延迟移植肾功能后，差异消失。因IgA复发导致移植肾丢失的仅为3%。
IgAN复发率为32%。一半患者的组织学诊断并未伴有尿常规异常。完全DR匹配和环孢素与未复发相关。
