活体供肾移植中移植后免疫球蛋白A肾病的二十年结局
Two Decades Outcomes of Posttransplant Immunoglobulin A Nephropathy in Live Donor Renal Transplantation.
作者信息
Khurana Mudit, Prasad Narayan, Behera Manas, Yachha Monika, Kushwaha Ravi, Agarwal Vinita, Bhadauria Dharmendra, Kaul Anupama, Patel Manas, Jain Manoj
机构信息
Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
出版信息
Indian J Nephrol. 2022 Jul-Aug;32(4):312-319. doi: 10.4103/ijn.ijn_234_21. Epub 2022 May 20.
BACKGROUND
The data on long-term outcomes of posttransplant immunoglobulin A nephropathy (IgAN) are confounding and vary with geography and ethnicity worldwide. We aimed to study the long-term graft outcomes of patients with posttransplant IgAN in the northern Indian cohort.
METHODS
The long-term graft outcomes of 51 live donor renal transplant recipients with biopsy-proven posttransplant IgAN (recurrence/de novo) were analyzed. The risk factors for graft failure in the posttransplant IgA groups were analyzed using the Cox regression analysis.
RESULTS
Out of the total of 51 patients who had posttransplant IgAN, 40 patients had a biopsy-proven native kidney IgAN. The mean duration of the clinical presentation of posttransplant IgAN was 62.4 months (5.2 years) posttransplant. Proteinuria at the time of biopsy was 3.03 ± 2.2 g/day, and 41.2% had proteinuria of more than 3 g/day at the time of biopsy. The estimated 1, 5, 10, and 20 years patient survival was 98%, 95.4%, 75.9%, and 25.2%, respectively, and the estimated 1, 5, 10, and 20 years graft survival was 98%, 88.5%, 44.6%, and 11.9%, respectively, in patients who had posttransplant IgA. Many of the traditional risk factors associated with progression in native kidney IgAN, such as the degree of proteinuria, Oxford MEST (mesangial and endocapillary hypercellularity, segmental sclerosis, and interstitial fibrosis/tubular atrophy) scoring, recipient's age, and sex were not predictive of early graft failure among patients with posttransplant IgAN. In our cohort, the only significant graft failure predictor was serum creatinine at 5 years. Chronic antibody-mediated rejection (ABMR) was seen in 21.6% of patients with posttransplant IgAN. Whether this coexistence of chronic ABMR is an incidental finding or posttransplant IgAN predisposes to chronic ABMR requires further investigation.
CONCLUSION
Posttransplant IgAN is associated with poor long-term graft outcomes in live donor renal transplants. Proteinuria and MEST scoring were not predictive of graft failure in living donor posttransplant IgAN.
背景
移植后免疫球蛋白A肾病（IgAN）的长期预后数据存在混淆，且因全球不同地区和种族而有所差异。我们旨在研究印度北部队列中移植后IgAN患者的长期移植肾预后。
方法
分析了51例经活检证实为移植后IgAN（复发/新发）的活体供肾肾移植受者的长期移植肾预后。采用Cox回归分析移植后IgA组移植肾失败的危险因素。
结果
在51例移植后IgAN患者中,40例经活检证实为原发性IgAN。移植后IgAN临床表现的平均持续时间为移植后62.4个月（5.2年）。活检时蛋白尿为3.03±2.2g/天，41.2%的患者活检时蛋白尿超过3g/天。移植后IgA患者的1年、5年、10年和20年预计患者生存率分别为98%、95.4%、75.9%和25.2%，1年、5年、10年和20年预计移植肾生存率分别为98%、88.5%、44.6%和11.9%。许多与原发性IgAN进展相关的传统危险因素，如蛋白尿程度、牛津MEST（系膜和内皮细胞增生、节段性硬化和间质纤维化/肾小管萎缩）评分、受者年龄和性别，在移植后IgAN患者中并不能预测早期移植肾失败。在我们的队列中，唯一显著的移植肾失败预测因素是5年时的血清肌酐。21.6%的移植后IgAN患者出现慢性抗体介导的排斥反应（ABMR）。这种慢性ABMR的共存是偶然发现还是移植后IgAN易发生慢性ABMR，需要进一步研究。
结论
移植后IgAN与活体供肾肾移植的长期移植肾不良预后相关。蛋白尿和MEST评分不能预测活体供肾移植后IgAN的移植肾失败。
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