Abstract: SA-PO529

When Post-Transplant IgA Deposition Is Not Recurrence

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Kennedy, Claire, Beaumont Hospital, Dublin, Ireland
  • McMahon, Darren, University College Dublin, Monaghan, Ireland
  • Waldron, Orna, Royal College of Surgeons in Ireland, Dublin, Ireland
  • Fitzmaurice, Andrea M, Beaumont Hospital, Dublin 9, Ireland
  • O'kelly, Patrick, Beaumont Hospital, Dublin 9, Ireland
  • Finan, Megan R, Beaumont hospital, Dublin 1, Ireland
  • Doyle, Brendan, Beaumont Hospital, Dublin 9, Ireland
  • Dorman, Anthony M., Beaumont Hospital, Dublin 9, Ireland
  • Conlon, Peter J., Beaumont Hospital, Dublin 9, Co Dublin, Ireland
Background

Immunoglobulin A (IgA) deposition in the post-transplant setting usually represents disease recurrence but can occasionally represent donor-related or de novo disease. We aimed to examine post-transplant outcomes in the setting of donor-related or de novo IgA deposition and compare patient and graft outcomes in these cohorts to those in all other Irish renal transplant recipients during a similar time period.

Methods

All renal biopsy records from 1/1/1995 to 31/12/2012 (n=7296) were reviewed to identify those with post-transplant IgA deposition. Detailed chart review was performed to identify those in whom the IgA deposition was deemed donor-related (<6 months post-transplant) or de novo (>6 months post-transplant) as opposed to recurrent. A retrospective research MEST score (0-7) was assigned to each biopsy. The National Kidney Transplant Service database was accessed to facilitate a comparison of patient and graft outcomes in these cohorts and all other renal transplant recipients.

Results

Fifteen cases of post-transplant IgA deposition were deemed to be donor-related (fourteen deceased donors) and had a mean research MEST score of 1.65 (range 0.32-3.03). Serial biopsies in seven of these cases showed resolution of the deposits over time.
Eight cases were deemed to represent de novo IgA deposition. The mean research MEST score, which is less specific in this setting, was 2.60 (range 1-4).
There were no differences in patient and graft survival rates in these groups compared to all other transplants performed during a similar time period. Cox regression multivariate analysis did not identify either donor-related or de novo IgA deposition as a contributing factor to patient or graft survival.

Conclusion

Cases of donor-related or de novo IgA deposition were infrequently encountered in our review of ‘for-cause’ biopsies. Neither condition, when histologically mild-moderate, was found to impact on patient or graft survival rates. These results cannot be extrapolated to the setting of living donation. This information is important for prognostication and counselling purposes in selected future cases.