Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China.
Department of Nephrology, University-Town Hospital of Chongqing Medical University, Chongqing 401331, China.
Transpl Immunol. 2023 Aug;79:101850. doi: 10.1016/j.trim.2023.101850. Epub 2023 May 12.
Immunoglobulin A nephropathy (IgAN) is a main cause of end stage renal disease (ESRD). Many IgAN patients with ESRD accept kidney allograft for renal replacement. However, disease recurrence occurs after transplantation. Galactose-deficient immunoglobulin A1(Gd-IgA1) has been proved to be a crucial biomarker in the primary IgAN population.
This meta-analysis aimed to explore the association between serum Gd-IgA1 and IgAN recurrence after renal transplantation and was registered on PROSPERO: CRD42022356952; A literature search was performed and relevant studies were retrieved from the PubMed, Embase and Cochrane library databases from inception to April 27, 2023. The inclusion criteria were: 1) full-text studies; 2) patients with histological diagnosis of IgAN of their native kidneys who underwent kidney transplantation; 3) studies exploring the relationship between serum Gd-IgA1 and IgAN recurrence after kidney transplantation. The exclusion criteria were: 1) reviews, case reports, or non-clinical studies. 2) studies with insufficient original data or incomplete data. 3) studies with duplicated data. Study quality was assessed using Newcastle Ottawa Scale (NOS). Data were pooled using a random-effects model.
8 full-text studies including 515 patients were identified. The Newcastle-Ottawa Scale (NOS) score ranged from 6 to 8. The standard mean difference (SMD) of the level of Gd-IgA1 was significantly higher in recurrence group than in non-recurrence group (SMD = 0.50，95%CI = 0.15-0.85, p = 0.005). Furthermore, Gd-IgA1 levels were higher in recurrence patients than in non-recurrence in both Europe subgroup (SMD 0.45, 95%CI: 0.08-0.82, p = 0.02) and Asia subgroup (SMD 0.90, 95%CI: 0.10-1.70, p = 0.03). However, pretransplant Gd-IgA1 levels showed no significant difference between recurrence and non-recurrence group (SMD 0.46, 95%CI: 0.06-0.99, p = 0.08) in anther subgroup analysis while posttransplant Gd-IgA1 levels were significantly higher in recurrence population than in non-recurrence (SMD 0.57, 95%CI 0.21 to 0.92, p = 0.002).
This meta-analysis showed that posttransplant serum Gd-IgA1 levels are associated with IgAN recurrence after kidney transplantation; however, pretransplant serum Gd-IgA1 levels are not.
免疫球蛋白 A 肾病（IgAN）是终末期肾病（ESRD）的主要原因。许多 ESRD 的 IgAN 患者接受肾移植进行肾脏替代治疗。然而，移植后会发生疾病复发。缺乏半乳糖的免疫球蛋白 A1（Gd-IgA1）已被证明是原发性 IgAN 人群中的一个关键生物标志物。
本荟萃分析旨在探讨血清 Gd-IgA1 与肾移植后 IgAN 复发之间的关系，并在 PROSPERO 上进行了注册：CRD42022356952；从成立到 2023 年 4 月 27 日，从 PubMed、Embase 和 Cochrane 图书馆数据库中进行了文献检索并检索到相关研究。纳入标准为：1）全文研究；2）接受过肾移植的具有其自身肾脏 IgAN 组织学诊断的患者；3）探讨血清 Gd-IgA1 与肾移植后 IgAN 复发之间关系的研究。排除标准为：1）综述、病例报告或非临床研究。2）原始数据不足或数据不完整的研究。3）具有重复数据的研究。使用纽卡斯尔-渥太华量表（NOS）评估研究质量。使用随机效应模型汇总数据。
确定了 8 项包含 515 名患者的全文研究。纽卡斯尔-渥太华量表（NOS）评分范围为 6 至 8 分。复发组的 Gd-IgA1 水平的标准均数差（SMD）明显高于非复发组（SMD=0.50，95%CI=0.15-0.85，p=0.005）。此外，在欧洲亚组（SMD 0.45，95%CI：0.08-0.82，p=0.02）和亚洲亚组（SMD 0.90，95%CI：0.10-1.70，p=0.03）中，复发患者的 Gd-IgA1 水平均高于非复发患者。然而，在另一个亚组分析中，复发和非复发组之间的移植前 Gd-IgA1 水平没有显著差异（SMD 0.46，95%CI：0.06-0.99，p=0.08），而移植后 Gd-IgA1 水平在复发人群中明显高于非复发人群（SMD 0.57，95%CI 0.21 至 0.92，p=0.002）。
本荟萃分析表明，移植后血清 Gd-IgA1 水平与肾移植后 IgAN 复发有关；然而，移植前血清 Gd-IgA1 水平则不然。
