Department of Medical Sciences, Renal Transplantation Unit 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
Division of Pathology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
Clin Transplant. 2018 Apr;32(4):e13207. doi: 10.1111/ctr.13207. Epub 2018 Feb 20.
Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis; the reported recurrence rate of IgAN after renal transplantation is as high as 13%-50%. The impact of immunosuppressive therapy and steroid withdrawal on the risk of recurrence of IgAN is still under debate. We performed a retrospective single-center study, selecting 123 kidney transplants (rtx) in 120 patients, between January 1995 and December 2012, with IgAN on the native kidney. In 51 of 123 transplants, at least one post-transplantation biopsy for clinical indication was performed; in 28 of 51 transplants, IgAN recurrence (IgANr) was demonstrated. This group (G1; N = 28) was compared with a group without IgANr (G2; N = 23). In our study, clinically evident IgANr rate was 54.9% (28/51) on biopsied patients. At discharge, the use of the immunosuppressant drugs (tacrolimus, cyclosporine A, mycophenolate mofetil, azathioprine, mTor inhibitors) was not associated with an increased risk of IgANr (P = NS). At discharge, all patients were steroid treated. Neither the use of tacrolimus, mycophenolate mofetil, nor mTor inhibitors (mTori) at biopsy time were associated with IgANr. However, IgANr was significantly higher in patients who experienced steroid withdrawal at any post-transplantation time (OR 7.7 P = .03). The median time to recurrence after steroid withdrawal was 59 months (min 4.18, max 113.2).
免疫球蛋白 A 肾病 (IgAN) 是最常见的原发性肾小球肾炎；据报道，IgAN 肾移植后的复发率高达 13%-50%。免疫抑制治疗和类固醇停药对 IgAN 复发风险的影响仍存在争议。我们进行了一项回顾性单中心研究，选择了 1995 年 1 月至 2012 年 12 月期间 120 例患者的 123 例肾移植（rtx），这些患者的原肾均患有 IgAN。在 123 例移植中，有 51 例至少进行了一次因临床指征的移植后活检；在这 51 例移植中，有 28 例显示 IgAN 复发（IgANr）。该组（G1；N=28）与无 IgANr 组（G2；N=23）进行比较。在我们的研究中，活检患者的临床明显 IgANr 发生率为 54.9%（28/51）。出院时，免疫抑制剂（他克莫司、环孢素 A、霉酚酸酯、硫唑嘌呤、mTor 抑制剂）的使用与 IgANr 风险增加无关（P=NS）。出院时，所有患者均接受类固醇治疗。活检时使用他克莫司、霉酚酸酯或 mTor 抑制剂（mTori）均与 IgANr 无关。然而，任何移植后时间内类固醇停药的患者 IgANr 发生率显著更高（OR 7.7，P=0.03）。类固醇停药后复发的中位时间为 59 个月（最小 4.18，最大 113.2）。
