Favorable long-term renal graft survival in primary glomerulonephritis

Last Updated: 2015-12-07

By Will Boggs MD

NEW YORK (Reuters Health) - Patients with primary glomerulonephritis (GN) generally have favorable long-term kidney transplant outcomes, according to new findings.

Although glomerulonephritis is a leading cause of end-stage renal disease (ESRD) and the need for renal replacement therapy, details about long-term transplant outcomes remain sparse, researchers say.

Dr. Maria Pippias from Academic Medical Center in Amsterdam and colleagues used data from the European Renal Association-European Dialysis and Transplant Association Registry to quantify 15-year kidney allograft survival probability in patients with primary GN. They compared these results with those of patients with autosomal dominant polycystic kidney disease (ADPKD).

Among more than 55,000 adult recipients of a first kidney transplant, 6,327 had a definitive diagnosis of primary GN and 8,056 had a potential diagnosis of primary GN. Median follow-up after transplantation was 74.3 months.

The death-adjusted 15-year graft survival rates were lowest for membranoproliferative GN (MPGN) I (56.7%) and II (56.5%) and highest for immunoglobulin A nephropathy (IgAN) (68.9%). By comparison, the rate for ADPKD was 76.6%, the researchers report in Transplantation, online November 19.

All GNs except IgAN had a greater risk of death-adjusted graft failure compared with ADPKD. The risk of graft failure for IgAN did not differ from that for ADPKD until 10 years after transplantation, after which the risk of graft loss was greater in the IgAN group.

Death-adjusted graft failure rates were lower for living-donor transplants than for deceased-donor transplants in the IgAN, membranous nephropathy (MN), and "other" groups, but not within the MPGN I and II groups.

As for the focal segmental glomerulosclerosis (FSGS) group, living-related-donor transplants had a lower risk of death-adjusted graft failure at five and 10 years, but not at 15 years, compared with deceased-donor transplants.

"Kidney transplants in patients with all types of primary GN, in which the native disease could recur, including IgAN, eventually have a greater risk of 15-year death-adjusted graft failure compared to ADPKD in which the original disease cannot recur," the researchers conclude.

"The results of this study are important to aid nephrologists in the pretransplant counseling of potential renal transplant recipients and donors about risk of graft loss, particularly when considering donor type," they add.

Dr. Michelle Marie O'Shaughnessy from Stanford University in Stanford, California, who was not involved in the European research, is currently working on a similar study using U.S. data.

She told Reuters Health by email that she was surprised by "the marked disparities in transplant outcomes between GN subtypes (with IgAN and MPGN at opposite ends of the spectrum), suggesting that the current research paradigm to group all GN subtypes together into a single disease category when examining transplant outcomes is faulty."

"All GN subtypes are not equal," Dr. O'Shaughnessy said. "Decisions regarding choice of kidney donor, counseling regarding risks of graft failure, and approaches to disease monitoring after transplantation should not be generic, but rather should be tailored toward each patient's specific GN subtype."

"Reasons for the observed disparities require further exploration," she said. "If it is proven that the increased risk for graft failure among patients with MPGN is due to GN recurrence, then increased attention to early markers of GN recurrence (e.g., closer monitoring of proteinuria, serum complement, etc.) and the development of strategies to effectively treat GN recurrence should be prioritized."

Dr. Pippias declined to comment.

SOURCE: http://bit.ly/1R4ZEEc

Transplantation 2015.