Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy

被引:0
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作者
Rodrigo, Emilio [1 ]
Quintana, Luis F. [2 ]
Vazquez-Sanchez, Teresa [3 ]
Sanchez-Fructuoso, Ana [4 ]
Buxeda, Anna [5 ]
Gavela, Eva [6 ]
Cazorla, Juan M. [7 ]
Cabello, Sheila [8 ]
Beneyto, Isabel [9 ]
Lopez-Oliva, Maria O. [10 ]
Diekmann, Fritz [2 ]
Gomez-Ortega, Jose M. [11 ]
Romero, Natividad Calvo [4 ]
Perez-Saez, Maria J. [5 ]
Sancho, Asuncion [6 ]
Mazuecos, Auxiliadora [7 ]
Espi-Reig, Jordi [9 ]
Jimenez, Carlos [10 ]
Hernandez, Domingo [3 ]
机构
[1] Hosp Univ Marques Valdecilla, Nephrol Dept, IDIVAL, Santander, Spain
[2] Hosp Clin Barcelona, Nephrol & Renal Transplantat Dept, Barcelona, Spain
[3] Hosp Univ Reg Malaga, Nephrol Dept, Malaga, Spain
[4] Univ Complutense, Hosp Clin San Carlos, Nephrol Dept, Fac Med, Madrid, Spain
[5] Hosp Mar, Nephrol Dept, Barcelona, Spain
[6] Hosp Univ Dr Peset, FISABIO, Nephrol Dept, Valencia, Spain
[7] Hosp Univ Puerta Mar, Nephrol Dept, Cadiz, Spain
[8] Hosp Univ Son Espases, Nephrol Dept, Mallorca, Spain
[9] Hosp Univ La Fe, Nephrol Dept, Kidney Transplant Unit, Valencia, Spain
[10] Hosp Univ La Paz, Nephrol Dept, Madrid, Spain
[11] Hosp Univ Marques Valdecilla, Pathol Dept, IDIVAL, Santander, Spain
关键词
graft loss; IgA nephropathy; inflammation; kidney transplantation; recurrence; IMMUNOGLOBULIN-A NEPHROPATHY; KIDNEY-TRANSPLANTATION; OXFORD CLASSIFICATION; RENAL-TRANSPLANTATION; GLOMERULONEPHRITIS;
D O I
10.1093/ckj/sfad259
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background Immunoglobulin A nephropathy (IgAN) is the most frequent recurrent disease in kidney transplant recipients and its recurrence contributes to reducing graft survival. Several variables at the time of recurrence have been associated with a higher risk of graft loss. The presence of clinical or subclinical inflammation has been associated with a higher risk of kidney graft loss, but it is not precisely known how it influences the outcome of patients with recurrent IgAN.Methods We performed a multicentre retrospective study including kidney transplant recipients with biopsy-proven recurrence of IgAN in which Banff and Oxford classification scores were available. 'Tubulo-interstitial inflammation' (TII) was defined when 't' or 'i' were >= 2. The main endpoint was progression to chronic kidney disease (CKD) stage 5 or to death censored-graft loss (CKD5/DCGL).Results A total of 119 kidney transplant recipients with IgAN recurrence were included and 23 of them showed TII. Median follow-up was 102.9 months and 39 (32.8%) patients reached CKD5/DCGL. TII related to a higher risk of CKD5/DCGL (3 years 18.0% vs 45.3%, log-rank 7.588, P = .006). After multivariate analysis, TII remained related to the risk of CKD5/DCGL (HR 2.344, 95% CI 1.119-4.910, P = .024) independently of other histologic and clinical variables.Conclusions In kidney transplant recipients with IgAN recurrence, TII contributes to increasing the risk of CKD5/DCGL independently of previously well-known variables. We suggest adding TII along with the Oxford classification to the clinical variables to identify recurrent IgAN patients at increased risk of graft loss who might benefit from intensified immunosuppression or specific IgAN therapies. Graphical Abstract
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页数:8
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