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Abstract: SA-OR107

Post-Transplant Recurrence of IgA Nephropathy: HLA as a Predictive Factor

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Kavanagh, Catherine R., Columbia University Irving Medical Center, New York, New York, United States
  • Jain, Namrata Gargee, Columbia University Irving Medical Center, New York, New York, United States
  • Kamal, Jeanne, Columbia University Irving Medical Center, New York, New York, United States
  • Vasilescu, Elena Rodica, Columbia University Irving Medical Center, New York, New York, United States
  • Batal, Ibrahim, Columbia University Irving Medical Center, New York, New York, United States
Background

In the native kidney, studies have suggested that specific Human Leukocyte Antigen (HLA) alleles have increased risk or protective effects for the development of IgA Nephropathy (IgAN). There remains limited knowledge of the clinical significance and specific factors that contribute to recurrence of IgAN in the kidney allograft. We aimed to study whether the degree of HLA matching and the presence of certain HLA loci in the donor and recipient can contribute to recurrence.

Methods

A retrospective cohort of 159 recipients with ESRD secondary to IgAN who were transplanted at our center between 1995 and 2017 were evaluated for recurrent disease. Clinical characteristics and HLA typing were analyzed in both donor and recipient.

Results

Of the 159 patients identified, 53 (33%) had biopsy-proven recurrent IgAN. On follow-up, 16/53 (30%) of patients with recurrent IgAN developed graft failure compared to 11/106 (10%) of patients without proven recurrence (P= 0.046, See Figure). Univariate Cox proportional hazards analysis has identified that younger recipient age at transplantation, receiving allograft from living donors, higher degree of HLA matching, recipient HLA-DR15, and donor HLA-DR3 to be significantly associated with recurrence. By multivariable Cox analysis, younger recipient age [HR 0.97 (95% CI: 0.94 – 0.99), P= 0.016], HLA mismatch [0.83 (0.70- 0.98), P=0.03], presence of HLA-DR15 in the recipient [2.58 (1.36-4.88), P= 0.004], as well as the presence of HLA-DR3 in the donor [2.57 (1.23-5.37), P= 0.012] were independently associated with recurrent IgAN.

Conclusion

Recurrence of IgAN is associated with decreased graft survival. In an effort to improve long-term outcome, it is imperative to consider factors that increase recurrence risk when evaluating potential donors, such as higher HLA matching and the presence of HLA-DR3 in the donor. Recipient variables of younger age and HLA-DR15 were also independent predictors for recurrent IgAN.

Graft Survival