Department of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain,
Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain,
Am J Nephrol. 2020;51(5):357-365. doi: 10.1159/000506853. Epub 2020 Mar 18.
Recurrence of immunoglobulin (Ig)A nephropathy (rIgAN) is a growing cause of kidney allograft dysfunction. This study was aimed at investigating factors associated with rIgAN and the subsequent progression to end-stage renal disease (ESRD).
Retrospective study including consecutive patients with IgA nephropathy (IgAN) who received a kidney transplant in our center between 1992 and 2016 and had a renal biopsy by clinical indication. The date of detection of chronic kidney disease (CKD) 5 was used as renal outcome.
Eighty-six kidney transplants were performed in patients with IgAN, 38 (44%) were from living donors (related n = 26). rIgAN was diagnosed in 23 allografts (27%). Renal function and proteinuria at the end of the follow-up period were worst in the rIgAN patients compared to those without rIgAN (2.2 vs. 1.4 mg/dL, p = 0.014, and 1.16 vs. 0.49 g/day, p = 0.005, respectively). Risk of rIgAN and progression to CKD 5 decreased with patient's age (hazard ratio [HR] 0.95, 95% CI 0.92-0.98, p = 0.002, and HR 0.97, 95% CI 0.83-0.97, p = 0.008 per year, respectively). Patients with rIgAN had a higher risk of progression to CKD 5 (HR 6.7, 95% CI 1.3-35.7, p = 0.025). Full donor-recipient mismatch in the human leukocyte antigen (HLA)-B loci decreased the risk of rIgAN (HR 0.22, 95% CI 0.06-0.76, p = 0.017).
rIgAN was an independent risk factor for ESRD after renal allograft. Younger age increased the risk of rIgAN and CKD 5. Conversely, HLA-B mismatching was a potential protective factor for rIgAN of this glomerular disease.
免疫球蛋白 A 肾病（rIgAN）的复发是导致肾移植功能障碍的一个日益严重的原因。本研究旨在探讨与 rIgAN 相关的因素以及随后进展为终末期肾病（ESRD）的情况。
这是一项回顾性研究，纳入了 1992 年至 2016 年期间在我们中心接受肾移植且因临床指征行肾活检的连续 IgA 肾病（IgAN）患者。以检测到慢性肾脏病（CKD）5 期的日期作为肾脏结局。
86 例 IgAN 患者接受了肾移植，其中 38 例（44%）为活体供者（相关患者 n = 26）。23 例移植肾中诊断为 rIgAN（27%）。与无 rIgAN 患者相比，rIgAN 患者的终末随访时肾功能和蛋白尿最差（2.2 与 1.4 mg/dL，p = 0.014，1.16 与 0.49 g/天，p = 0.005）。rIgAN 的风险和进展为 CKD 5 的风险随着患者年龄的增加而降低（风险比[HR] 0.95，95%置信区间 0.92-0.98，p = 0.002，和 HR 0.97，95%置信区间 0.83-0.97，p = 0.008/年）。有 rIgAN 的患者进展为 CKD 5 的风险更高（HR 6.7，95%置信区间 1.3-35.7，p = 0.025）。HLA-B 位点的完全供受者错配降低了 rIgAN 的风险（HR 0.22，95%置信区间 0.06-0.76，p = 0.017）。
rIgAN 是肾移植后发生 ESRD 的独立危险因素。年龄较小会增加 rIgAN 和 CKD 5 的风险。相反，HLA-B 错配是这种肾小球疾病 rIgAN 的潜在保护因素。
