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Risk for graft loss in pediatric and young adult kidney transplant recipients due to recurrent IgA nephropathy
被引:1
作者:
Engen, Rachel M.
[1
,5
]
Bartosh, Sharon M.
[1
]
Smith, Jodi M.
[2
]
Perkins, James D.
[3
]
Harshman, Lyndsay A.
[4
]
机构:
[1] Univ Wisconsin Madison, Madison, WI USA
[2] Univ Washington Seattle, Washington, DC USA
[3] Univ Washington, Div Transplant Surg, Clin & Bioanal Transplant Lab CBATL, Dept Surg, Seattle, WA USA
[4] Univ Iowa Organ Transplant Ctr, Iowa City, IA USA
[5] 600 Highland Ave, Madison, WI 53792 USA
关键词:
IgAN;
allograft loss;
kidney transplant;
pediatric;
young adult;
prednisone;
FOCAL SEGMENTAL GLOMERULOSCLEROSIS;
RENAL-TRANSPLANTATION;
POSTTRANSPLANT RECURRENCE;
RETROSPECTIVE ANALYSIS;
IMPACT;
NEPHRITIS;
ALLOGRAFT;
SURVIVAL;
CHILDREN;
GROWTH;
D O I:
10.1016/j.ajt.2023.08.007
中图分类号:
R61 [外科手术学];
学科分类号:
摘要:
IgA nephropathy (IgAN) is associated with a risk for posttransplant recurrence. Data are limited regarding graft loss attributable to recurrence of IgAN among pediatric and young adult kidney transplant (KT) recipients. This was a retrospective cohort study of patients aged 0 to 25 years from the Scientific Registry of Transplant Recipients who received a primary KT for IgAN. Patients with history of KT attributable to renal dysplasia were comparators. Outcomes included the incidence of graft loss attributable to IgAN recurrence, association with donor type, and posttransplant corticosteroid use. In total, 5475 transplant recipients were included, with 1915 patients with IgAN and 3560 patients with renal dysplasia. In a multivariable Cox proportional hazards model, IgAN was associated with higher risk of graft loss (adjusted hazard ratio [aHR], 1.35; 95% CI, 1.21-1.50; P < .001) compared with dysplasia. Graft loss was attributed to recurrent disease in 5.4% of patients with IgAN. In a multivariable competing risks analysis, patients with IgAN receiving a parental living-donor kidney were more likely to report graft loss from recurrent disease compared with patients with a nonparental living donor (aHR, 0.52; 95% CI, 0.31-0.91; P = .02). Posttransplant prednisone use was not associated with improved graft survival (P = .2). These data challenge existing paradigms in posttransplant management of patients with IgAN.
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页码:37 / 45
页数:9
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