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Abstract: TH-PO652

Post-Transplant Recurrence of Glomerular Diseases: Analysis of the CureGN Database

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Efe, Orhan, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Taborda Ribas, Guilherme, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Larkina, Maria, University of Michigan, Ann Arbor, Michigan, United States
  • Al Jurdi, Ayman, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Hullekes, Frank E., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
  • Riella, Leonardo V., Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Post-transplant recurrence of glomerular diseases is one of the leading causes of kidney graft failure. Identification of risk factors and predictive biomarkers are needed to guide management.

Methods

CureGN is a prospective multicenter international consortium of patients with biopsy-proven minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), IgA nephropathy/vasculitis (IgAN), and membranous nephropathy (MN). We included pediatric and adult patients from CureGN who underwent deceased or living kidney transplantation. The primary outcome was the risk of post-transplant recurrence. Recurrences were evaluated using a log-rank test. For secondary outcomes, clinical features of recurrent and non-recurrent patients were compared by t-test, Mann-Whitney, or Fisher’s exact test. Risk factors of post-transplant recurrence were analyzed by Cox regression.

Results

A total of 144 patients were enrolled, including 19 MCD, 68 FSGS, 51 IgAN, and 6 MN. Overall, the mean age was 29.7±18.8, 46 (32%) were pediatric, 87 (60%) were male, and 88 (61%) were White. During a mean follow-up of 31.9±20.7 months, post-transplant recurrence occurred in 32%, 15%, and 12% of MCD, FSGS, and IgAN patients, respectively. None of the MN patients had a recurrence. In MCD and FSGS, the mean time to recurrence was 7.8±13.5 and 14.7±18.6 months, respectively (Fig.1A). In the combined analysis of MCD and FSGS, none of the variables were associated with increased risk of recurrence (Fig.1B). All of the recurrent patients had dialysis pre-transplant, while 64% in the non-recurrent group (P = 0.002). For IgAN, the mean time to recurrence was 10.9±12.6 months and there was a tendency toward less White and more pre-transplant dialysis in the recurrent group. Overall, having a recurrence was associated with decreased post-transplantation eGFR in FSGS (HR 15.1, CI 13-17.3) and IgAN (HR 27, CI 22.4-31.7) in linear regression after adjusting for time.

Conclusion

In the diverse CureGN cohort, post-transplant recurrence was most common in MCD, followed by FSGS and IgAN. The recurrence of FSGS and IgAN was associated with reduced kidney graft function.