Clinical Characteristics and Long-term Outcome of Glomerulonephritis in Renal Allografts.
- Author:
Ki Tae LEE
1
;
Seung Yeup HAN
;
Sung Bae PARK
;
Hyun Chul KIM
Author Information
1. Department of Internal Medicine, Dongsan Kidney Institute, Keimyung University School of Medicine, Daegu, Korea. K780121@dsmc.or.kr
- Publication Type:Original Article
- Keywords:
Post-transplant glomerulonephritis;
Proteinuria;
Graft survival
- MeSH:
Allografts*;
Biopsy;
Cyclosporine;
Diabetic Nephropathies;
Diagnosis;
Glomerulonephritis*;
Glomerulonephritis, IGA;
Glomerulonephritis, Membranoproliferative;
Glomerulonephritis, Membranous;
Glomerulosclerosis, Focal Segmental;
Graft Survival;
Humans;
Kidney;
Natural History;
Prevalence;
Proteinuria;
Recurrence;
Transplants
- From:Korean Journal of Nephrology
2005;24(4):603-610
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Since the introduction of cyclosporine, the short-term renal allograft survival has significantly improved. However, the long-term success is still limited by the development of chronic rejection and recurrent disease. Post-transplant glomerulonephritis (post-Tx GN) including recurrent disease is becoming an important cause of graft dysfunction. METHODS: From November 1988 to June 2004, a total of 629 renal transplants involving 588 patients were performed at our medical center. RESULTS: The prevalence rate of post-Tx GN was 11.9% in 629 renal transplant. Among 75 transplants diagnosed as post-Tx GN, IgA nephropathy (62.7%) was the most common histologic diagnosis, followed by focal segmental glomerulosclerosis (26.7 %), membranous glomerulonephritis (8.0%), membranoproliferative glomerulonephritis (1.3%) and diabetic nephropathy (1.3%). Documented histologic recurrence occurred in only 24.2% of patients with prior biopsy-proven glomerulonephritis of their native kidneys. The actuarial allograft survival at 5 and 10 years posttransplantation with post-Tx GN was 80.5 % and 27.9%, respectively; and the corresponding graft survival for patients without post-Tx GN was 74.9% and 52.3%, respectively (p<0.05). However, there was no significant difference in the graft survival according to type of post-Tx GN. The 5 and 10 year graft survival for patients with proteinuria over than 3.5 g/24 hr were 62.5% and 0%, which is significantly lower compared with 85.3% and 28.7% for patients with proteinuria less than 3.5 g/24 hr (p<0.01). CONCLUSION: In conclusion, post-Tx GN is associated with decreased long-term graft survival and nephrotic range proteinuria is most important prognostic factor for graft survival. A prospective study with rigorous efforts to make pretransplant diagnosis and standardized criteria for allograft biopsy will more accurately characterize the natural history of post-Tx GN and may provide insight regarding treatment.
