Abstract: SA-PO528

Allograft Crescent Predicts Graft Failure in Recurrent IgA Nephropathy Patients

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Park, Sehoon, Seoul National University Hospital, SEOUL, Korea (the Republic of)
  • Cho, Hyunjeong, Seoul National University Hospital, SEOUL, Korea (the Republic of)
  • Yu, Mi-yeon, Seoul National University Hospital, SEOUL, Korea (the Republic of)
  • Kim, Yaerim, Seoul National University Hospital, SEOUL, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University Hospital, SEOUL, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University Hospital, SEOUL, Korea (the Republic of)
Background

Recent studies demonstrated the predictive value of crescent in IgA nephropathy (IgAN) prognosis. However, it remains unclear whether allograft crescent is associated with worse graft prognosis in patients with recurrent IgAN.

Methods

We reviewed 376 IgAN patients who received kidney transplantation from 1979-2016 in a university hospital in Korea. Allograft biopsies were performed when patients had a significant proteinuria, hematuria, or a progressive deterioration of renal function. Clinical and pathologic characteristics at the time of biopsy were collected in recurrent IgAN cases. The degree of the crescent formation was classified into prominent (> 10%), mild (0-10%), and none (0%). The renal outcome was death-censored graft failure (DCGF).

Results

During the follow-up duration of 7.0 (3.7-14.3) years, 122 (32.3%) patients were diagnosed as recurrent IgAN by allograft biopsy. Median time to recurrence was 4.1 (1.9-8.1) years. Recipients who recurred their IgAN were younger. They were donated allograft from younger donor and received less induction immunosuppressive treatment. Among the recurred IgAN patients, 36 (29.5%) reached graft failure after 9.3 (5.7-12.2) years from their transplantation. Moreover, IgAN recurrence itself was a strong time-dependent risk factor for DCGF (adjusted HR 2.703, 95% CI 1.608-4.545, P<0.001). Regarding the pathologic findings, crescent was identified in 20 patients with recurrent IgAN, in those with relatively old graft age, decreased renal function at the time of IgAN recurrence, and higher MEST scores. All five patients with prominent (>10%) crescent formation in their allograft biopsies progressed to consequent DCGF within from 0.4 to 4.6 years after the IgAN recurrence. Also, the presence of prominent (>10%) crescent in transplanted kidney was a strong risk factor for DCGF when compared with other recurrent IgAN patients without crescent formation (adjusted HR 6.313, 95% CI 1.699-23.458, P=0.006), even after adjustment of MEST scores and coexisting rejection.

Conclusion

Despite its rarity, a prominent allograft crescent (>10%) was demonstrated to attribute to rapid renal deterioration in recurrent IgAN patients. Treatment strategies for those patients should be investigated.