Cazorla-López Juan Manuel, Wu Julie, Villanego-Fernández Florentino, Naranjo-Muñoz Javier, Vigara-Sánchez Luis Alberto, García-García-Doncel Ana, Orellana-Chávez Cristhian, Moreno-Salazar Antonio, García-Álvarez Teresa, Mazuecos-Blanca Auxiliadora
Department of Nephrology, Hospital Puerta del Mar, Cadiz, Spain.
Department of Nephrology, Hospital Puerta del Mar, Cadiz, Spain.
Transplant Proc. 2020 Mar;52(2):515-518. doi: 10.1016/j.transproceed.2019.12.008. Epub 2020 Feb 7.
IgA nephropathy (IgAN) recurrence in the renal graft is variable. Several factors can influence the risk of recurrence of IgAN and renal graft failure. We carried out a retrospective observational study between the years 1990 and 2018. The study group was patients diagnosed, by means of biopsy, as having post-renal transplant (RT) IgAN in our hospital in the study period. The control group was patients with pre-RT histologic diagnosis of IgAN who did not develop recurrence of the disease after the RT. A total of 1535 RTs were performed in our center in the study period. Of those, 24 patients developed IgAN in the renal graft. The time elapsed from the RT to the development of allograft IgAN was 7 (SD, 5.3) years. The patients with allograft IgAN tended to be younger (P = .069), and HLA-DR4 was more common in these patients (P = .078). We observed a very significant difference in the use of induction immunosuppressive therapy (study group vs control group: 13.6% vs 57.7%, P < .001). The 3 patients who presented crescents in the biopsy specimen lost the renal graft. As in the native kidney, the presence of crescents is an indicator of poor prognosis. In our experience, the patients with post-RT IgAN received induction therapy less frequently; this finding would support the conclusion that such treatments should be applied to patients with pre-RT diagnosis of IgAN.
肾移植中IgA肾病（IgAN）的复发情况各异。多种因素可影响IgAN复发及肾移植失败的风险。我们在1990年至2018年期间开展了一项回顾性观察研究。研究组为在研究期间于我院经活检诊断为肾移植（RT）后IgAN的患者。对照组为RT前经组织学诊断为IgAN但RT后未发生疾病复发的患者。在研究期间，我们中心共进行了1535例RT。其中，24例患者在肾移植中发生了IgAN。从RT到同种异体移植IgAN发生的时间为7（标准差，5.3）年。发生同种异体移植IgAN的患者往往更年轻（P = 0.069），且这些患者中HLA - DR4更为常见（P = 0.078）。我们观察到诱导免疫抑制治疗的使用存在非常显著的差异（研究组与对照组：13.6%对57.7%，P < 0.001）。活检标本中出现新月体的3例患者失去了肾移植。与原发性肾脏一样，新月体的存在是预后不良的指标。根据我们的经验，RT后IgAN患者接受诱导治疗的频率较低；这一发现支持了应将此类治疗应用于RT前诊断为IgAN患者的结论。
