Sydney School of Public Health, University of Sydney, New South Wales, Australia; Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, New South Wales, Australia; ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia.
Transplantation Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, New South Wales, Australia; Australia and New Zealand Dialysis and Transplant Registry, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Kidney Int. 2017 Aug;92(2):461-469. doi: 10.1016/j.kint.2017.03.015.
Recurrent glomerulonephritis after kidney transplantation is a feared complication because it is unpredictable and may have a negative impact on graft outcomes. To better understand this we collected data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry accumulated over 30 years. The incidence, risk factors, and outcomes of recurrent glomerulonephritis in transplant recipients were determined using adjusted Cox proportional hazard and competing risk modeling. A total of 6,597 recipients with biopsy-proven glomerulonephritis as the primary cause of end-stage kidney disease were followed for 51,871 person-years (median duration 7.7 years). The four most common types of glomerulonephritis were IgA nephropathy in 2501 patients, focal segmental glomerulosclerosis (FSGS) in 1403, membranous in 376, and membranoproliferative (MPGN) nephropathy in 357 patients. Among these four types, recurrence was reported in 479 of 4637 patients, and of these, 212 lost their allograft due to recurrence. Older age at transplantation (adjusted hazard ratio [per year increase] 0.96 [95% confidence interval 0.95 - 0.97]) was associated with a lower risk of recurrence. Significantly, the five-year graft survival was 30% for recipients with recurrent MPGN and 57-59% for recipients with FSGS, IgA, and membranous nephropathy. Transplant recipients with recurrent disease were twice as likely to lose their allografts compared to those without recurrence (adjusted hazard ratio 2.04 [1.81-2.31]). Thus, recurrent glomerulonephritis remains a significant cause of graft loss in transplant recipients.
移植后复发性肾小球肾炎是一种令人担忧的并发症，因为它是不可预测的，可能对移植物的结局产生负面影响。为了更好地了解这一点，我们从澳大利亚和新西兰透析和移植（ANZDATA）登记处收集了超过 30 年的数据。使用调整后的 Cox 比例风险和竞争风险模型确定了移植受者复发性肾小球肾炎的发生率、危险因素和结局。共有 6597 名经活检证实为肾小球肾炎的患者作为终末期肾病的主要病因接受了随访，随访时间为 51871 人年（中位随访时间为 7.7 年）。四种最常见的肾小球肾炎类型为 IgA 肾病（2501 例）、局灶节段性肾小球硬化症（FSGS）（1403 例）、膜性肾病（376 例）和膜增殖性肾小球肾炎（MPGN）（357 例）。在这四种类型中，有 4637 例患者中有 479 例报告了复发，其中 212 例因复发而失去了全部移植物。移植时年龄较大（调整后的风险比[每年增加]0.96 [95%置信区间 0.95-0.97]）与复发风险较低相关。重要的是，复发性 MPGN 患者的 5 年移植物存活率为 30%，FSGS、IgA 和膜性肾病患者的 5 年移植物存活率为 57-59%。与无复发患者相比，复发性疾病患者失去移植物的可能性是其两倍（调整后的风险比为 2.04 [1.81-2.31]）。因此，复发性肾小球肾炎仍然是移植受者移植物丢失的一个重要原因。
