Frohnert P P, Donadio J V, Velosa J A, Holley K E, Sterioff S
Mayo Clinic and Foundation, Rochester, Minnesota, USA.
Clin Transplant. 1997 Apr;11(2):127-33.
IgA Nephropathy (IgA N) is one of the most common glomerulopathies and may lead to renal failure in 10-20% of cases. After renal transplantation, IgA N has a strong tendency to recur in the graft. Initially considered a benign condition, graft losses from recurrent IgA N have been reported over the last 20 yr, casting doubt on the initial premise. Since large single-center studies of the fate of renal allografts in IgA N are rare and the Mayo Clinic transplant experience for IgA N is extensive (dating back to 1970), a review of these issues appeared worthwhile.
A retrospective study was done of all renal transplant patients who had had biopsy-proven IgA N as underlying disorder. We extracted data on the underlying disease, history leading to renal transplantation, factors affecting transplant outcome, and on the course after transplantation with special attention to rejection activity and recurrence of the primary disease. Standard statistical methods were employed.
53 renal allografts were transplanted to 51 biopsy-proven IgA N patients: 12 were cadaveric (CAD) grafts, 3 HLA-mismatched living related donor (LRD) kidneys, 29 one haplotype-matched LRD and 9 HLA-identical LRD organs. Five-year actuarial graft survival was 100% in HLA-identical LRD, 88% in one haplotype-matched LRD, and 74% in CAD grafts. All three HLA-mismatched LRD kidneys were functioning up to 1.6 yr (longest follow-up). Only one patient died after acute rejection of the CAD graft. There were 3 early graft losses from acute rejection and 4 late losses. IgA N recurred in 26% of allograft and led to significant loss of graft function in 10 of the 14 patients (71%) over a long period of observation. Three of four late graft losses were in patients with recurrent IgA N. Recurrence was not related to the type of graft, i.e. CAD vs. LRD, nor to the extent of HLA-matching in LRD transplantation.
Renal transplantation in patients with IgA N has excellent patient and graft survival. There is a high rate of recurrence of the primary glomerulopathy in the renal allograft, and this event is by no means inconsequential. Loss of renal function and even graft loss occur over prolonged periods of time. There is no disadvantage getting a well matched LRD in regard to incidence of recurrent IgA N. Thus, we encourage LRD transplantation in IgA N.
IgA肾病（IgA N）是最常见的肾小球疾病之一，在10%-20%的病例中可能导致肾衰竭。肾移植后，IgA N在移植肾中有很强的复发倾向。IgA N最初被认为是一种良性疾病，但在过去20年里已有移植肾因IgA N复发而丧失功能的报道，这使最初的观点受到质疑。由于关于IgA N患者肾移植预后的大型单中心研究较少，且梅奥诊所对IgA N的移植经验丰富（可追溯到1970年），因此对这些问题进行综述似乎很有必要。
对所有经活检证实患有IgA N的肾移植患者进行回顾性研究。我们提取了关于基础疾病、导致肾移植的病史、影响移植结果的因素以及移植后病程的数据，特别关注排斥反应和原发性疾病的复发情况。采用标准统计学方法。
53个移植肾被移植给51例经活检证实患有IgA N的患者：12个为尸体供肾（CAD），3个为HLA配型不符的活体亲属供肾（LRD），29个为单倍型匹配的LRD肾，9个为HLA相同的LRD肾。HLA相同的LRD肾移植后5年预期移植肾存活率为100%，单倍型匹配的LRD肾为88%，CAD肾为74%。所有3个HLA配型不符的LRD肾在最长1.6年的随访期内均功能良好。仅1例患者在CAD肾急性排斥反应后死亡。有3例移植肾因急性排斥反应早期丧失功能，4例晚期丧失功能。IgA N在26%的移植肾中复发，在14例患者中的10例（71%）经过长期观察后导致移植肾功能显著丧失。4例晚期移植肾丧失功能的患者中有3例患有复发性IgA N。复发与移植肾类型（即CAD与LRD）无关，也与LRD移植中的HLA匹配程度无关。
IgA N患者肾移植后患者和移植肾存活率良好。原发性肾小球疾病在移植肾中的复发率很高，且这一事件绝非无关紧要。肾功能丧失甚至移植肾丧失功能会在较长时间内发生。在复发性IgA N的发生率方面，获得配型良好的LRD肾并无劣势。因此，我们鼓励在IgA N患者中进行LRD移植。
