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Kidney Week

Abstract: SU-OR50

Recurrence of IgA Nephropathy After Kidney Transplantation: TANGO Multicenter Study

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Uffing, Audrey, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Cravedi, Paolo, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Riella, Leonardo V., Brigham and Women's Hospital, Boston, Massachusetts, United States

Group or Team Name

  • TANGO-project
Background

In patients who received a kidney transplantation for end-stage renal disease (ESRD) due to IgA nephropathy, IgA deposits can recur in the transplanted kidney. The incidence, impact and predictors of these recurrent deposits is unclear.

Methods

As part of The Post-Transplant Glomerular Disease (TANGO) project, we performed a multicenter, international, retrospective study to determine the incidence, predictors and treatment response of recurrent IgA deposits after kidney transplantation. Patients with biopsy-proven IgA nephropathy, transplanted in the period 2005-2015 were selected in 16 TANGO centers in Europe, United States and Brazil.

Results

In a total of 504 patients, recurrent IgA deposits were identified by kidney biopsy in 82 patients (16%; 95%CI: 13-19), with a median time to recurrence of 3.4 years (IQR 1.4-5.7 years). Kaplan-Meier analysis showed similar graft survival between patients with and without recurrence in the first years after kidney transplant, though after 8 years, graft failure rates were higher in patients with recurrence (10 year death-censored graft survival 76% and 89%, respectively). Multivariable Cox-regression revealed a higher risk for IgA recurrence in patients with a pre-emptive kidney transplant (HR 2.56, 95%CI: 1.59-4.17), patients with DSA at time of transplant (HR 2.74, 95%CI: 1.22-6.14) and patients with shorter time from diagnosis to ESRD (HR 0.84 per month, 95%CI: 0.74-0.96). The presence of systemic auto-immune diseases associated with IgA nephropathy did not affect recurrence rates, nor did early steroid withdrawal. In multivariate analysis of post-transplant complications, de novo DSA was associated with recurrence of IgA deposits (HR 1.91, 95%CI: 1.04-3.51).

Conclusion

In our international cohort, IgA deposits recurred in 16% of patients and was associated with worse graft outcomes after 8 years of transplant compared to patients without recurrence. A pre-emptive transplant, shorter time from native diagnosis to ESRD, DSA at time of transplant and de novo DSA after kidney transplantation were associated with recurrence of IgA deposits