Yusuf Sabina, Alexander Suceena, Roy Sanjeet, Rebekah Grace, John Elenjickal Elias, Thomas Athul, Eapen Jeethu Joseph, David Vinoi George, Varughese Santosh
Department of Nephrology, Christian Medical College Vellore, Ranipet Campus, Ranipet, India.
Department of General Pathology, Christian Medical College Vellore, Ranipet Campus, Ranipet, India.
Indian J Nephrol. 2025 Mar-Apr;35(2):270-276. doi: 10.25259/IJN_39_2024. Epub 2024 Jul 15.
With significant advances in the understanding of transplant immunology and a reduction in rejection rates, significant improvements in kidney allograft survival have been seen. The problem of recurrent and denovo glomerular diseases after transplantation affecting graft outcomes remains and is poorly characterized. This study aimed to analyze the incidence, characteristics, and outcomes of glomerulonephritis (GN) after kidney transplant in the Indian subcontinent.
Data on patients who underwent kidney transplants in our hospital from 1971 to 2018 was analyzed. Patients who had biopsy proven glomerulonephritis after transplant were included in the study. Demographic factors, characteristics of glomerulonephritis after transplant, and patient and graft outcomes were studied.
Post-transplant glomerulonephritis was seen in 177 out of 3630 (4.8%) patients. IgA nephropathy (IgAN) was the most common type, followed by focal segmental glomerulosclerosis (FSGS) and thrombotic microangiopathy (TMA). Patients with IgAN and FSGS were younger, and native kidney disease was unknown in the majority (70% in IgAN and 40% in FSGS). Glomerulonephritis was the most common cause of graft loss. A serum creatinine level of ≥2 mg/dL at 1 year post-transplant was significantly associated with the risk of death and graft loss. In addition, the occurrence of glomerulonephritis within a year of transplant and cytomegalovirus (CMV) infection were found to be significant risk factors for death and graft loss, respectively.
Post transplant glomerulonephritis can significantly impact patient and graft outcomes. Understanding its etiology and pathogenesis is crucial to enabling its prevention and management and improving the outcomes of kidney transplantation.
随着移植免疫学认识的重大进展以及排斥反应率的降低，肾移植存活率有了显著提高。移植后复发性和新发肾小球疾病影响移植结果的问题仍然存在，且特征描述不足。本研究旨在分析印度次大陆肾移植后肾小球肾炎（GN）的发病率、特征和结局。
分析了1971年至2018年在我院接受肾移植患者的数据。纳入移植后经活检证实为肾小球肾炎的患者。研究了人口统计学因素、移植后肾小球肾炎的特征以及患者和移植结局。
3630例患者中有177例（4.8%）出现移植后肾小球肾炎。IgA肾病（IgAN）是最常见的类型，其次是局灶节段性肾小球硬化（FSGS）和血栓性微血管病（TMA）。IgAN和FSGS患者较年轻，大多数患者（IgAN中70%，FSGS中40%）的原发病肾病情况不明。肾小球肾炎是移植失败的最常见原因。移植后1年血清肌酐水平≥2mg/dL与死亡和移植失败风险显著相关。此外，移植后1年内发生肾小球肾炎和巨细胞病毒（CMV）感染分别被发现是死亡和移植失败的重要危险因素。
移植后肾小球肾炎可显著影响患者和移植结局。了解其病因和发病机制对于预防和管理该病以及改善肾移植结局至关重要。
