Clinical Predictors and Prognosis of Recurrent IgA Nephropathy in the Kidney Allograft

Catherine R. Kavanagh; Francesca Zanoni; Rita Leal; Namrata G. Jain; Megan Nicole Stack; Elena Rodica Vasilescu; Geo Serban; Carley Shaut; Jeanne Kamal; Satoru Kudose; António Martinho; Rui Alves; Dominick Santoriello; Pietro A. Canetta; David Cohen; Jai Radhakrishnan; Gerald B. Appel; Michael B. Stokes; Glen S. Markowitz; Vivette D. D’Agati; Krzysztof Kiryluk; Nicole K. Andeen; Ibrahim Batal

doi:10.1159/000519834

Clinical Predictors and Prognosis of Recurrent IgA Nephropathy in the Kidney Allograft

Catherine R. Kavanagh, Francesca Zanoni, Rita Leal, Namrata G. Jain, Megan Nicole Stack, Elena Rodica Vasilescu, Geo Serban, Carley Shaut, Jeanne Kamal, Satoru Kudose, António Martinho, Rui Alves, Dominick Santoriello, Pietro A. Canetta, David Cohen, Jai Radhakrishnan, Gerald B. Appel, Michael B. Stokes, Glen S. Markowitz, Vivette D. D’AgatiKrzysztof Kiryluk, Nicole K. Andeen, Ibrahim Batal

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Introduction: Although IgA nephropathy (IgAN) is the most common recurrent glomerulonephritis encountered in the kidney allograft, the clinical and immunogenetic characteristics remain poorly understood. We sought to study determinants and prognosis of recurrent IgAN with special focus on human leukocyte antigens (HLAs). Materials and Methods: Between 2005 and 2019, we identified 282 transplanted patients with failure secondary to IgAN from 2 North American and 1 European Medical Centers, including 80 with recurrent IgAN and 202 without recurrence. The prevalence of HLAs was compared to external healthy controls of European ancestry (n = 15,740). Graft survival was assessed by the Kaplan-Meier method and log rank test. Cox proportional hazards were used for multivariable analyses. Results: Compared to external controls of European ancestry, kidney transplant recipients of European ancestry with kidney failure secondary to IgAN had higher frequency of HLA-DQ5 (42% vs. 30%, OR = 1.68, p = 0.002) and lower frequency of HLA-DR15 (15% vs. 28%, OR = 0.46, p < 0.001) and HLA-DQ6 (32% vs. 45%, OR = 0.59, p = 0.003); however, the frequency of these HLAs were similar in recurrent versus nonrecurring IgAN. Younger recipient age at transplantation was an independent predictor of recurrence. HLA matching was an independent predictor for recurrent IgAN only in recipients of living-related but not deceased or living-unrelated transplants. Recurrent IgAN was an independent predictor of allograft failure, along with acute rejection. In patients with recurrent IgAN, serum creatinine at biopsy, degree of proteinuria, and concurrent acute rejection were associated with inferior allograft survival. Conclusion: Recurrent IgAN negatively affects allograft survival. Younger recipient age at transplantation is an independent predictor of recurrent IgAN, while the presence of HLAs associated with IgAN in the native kidney and HLA matching in recipients of deceased or living-unrelated transplants are not.

Original language	English (US)
Pages (from-to)	42-53
Number of pages	12
Journal	Glomerular Diseases
Volume	2
Issue number	1
DOIs	https://doi.org/10.1159/000519834
State	Published - Jan 2022

Keywords

Human leukocyte antigen matching
IgA nephropathy
Kidney transplantation
Pathology
Recurrent disease

ASJC Scopus subject areas

Nephrology

Access to Document

10.1159/000519834

Cite this

Kavanagh, C. R., Zanoni, F., Leal, R., Jain, N. G., Stack, M. N., Vasilescu, E. R., Serban, G., Shaut, C., Kamal, J., Kudose, S., Martinho, A., Alves, R., Santoriello, D., Canetta, P. A., Cohen, D., Radhakrishnan, J., Appel, G. B., Stokes, M. B., Markowitz, G. S., ... Batal, I. (2022). Clinical Predictors and Prognosis of Recurrent IgA Nephropathy in the Kidney Allograft. Glomerular Diseases, 2(1), 42-53. https://doi.org/10.1159/000519834

Kavanagh, CR, Zanoni, F, Leal, R, Jain, NG, Stack, MN, Vasilescu, ER, Serban, G, Shaut, C, Kamal, J, Kudose, S, Martinho, A, Alves, R, Santoriello, D, Canetta, PA, Cohen, D, Radhakrishnan, J, Appel, GB, Stokes, MB, Markowitz, GS, D’Agati, VD, Kiryluk, K, Andeen, NK & Batal, I 2022, 'Clinical Predictors and Prognosis of Recurrent IgA Nephropathy in the Kidney Allograft', Glomerular Diseases, vol. 2, no. 1, pp. 42-53. https://doi.org/10.1159/000519834

@article{071e6491f55f49989f5763ecbde231b4,

title = "Clinical Predictors and Prognosis of Recurrent IgA Nephropathy in the Kidney Allograft",

abstract = "Introduction: Although IgA nephropathy (IgAN) is the most common recurrent glomerulonephritis encountered in the kidney allograft, the clinical and immunogenetic characteristics remain poorly understood. We sought to study determinants and prognosis of recurrent IgAN with special focus on human leukocyte antigens (HLAs). Materials and Methods: Between 2005 and 2019, we identified 282 transplanted patients with failure secondary to IgAN from 2 North American and 1 European Medical Centers, including 80 with recurrent IgAN and 202 without recurrence. The prevalence of HLAs was compared to external healthy controls of European ancestry (n = 15,740). Graft survival was assessed by the Kaplan-Meier method and log rank test. Cox proportional hazards were used for multivariable analyses. Results: Compared to external controls of European ancestry, kidney transplant recipients of European ancestry with kidney failure secondary to IgAN had higher frequency of HLA-DQ5 (42% vs. 30%, OR = 1.68, p = 0.002) and lower frequency of HLA-DR15 (15% vs. 28%, OR = 0.46, p < 0.001) and HLA-DQ6 (32% vs. 45%, OR = 0.59, p = 0.003); however, the frequency of these HLAs were similar in recurrent versus nonrecurring IgAN. Younger recipient age at transplantation was an independent predictor of recurrence. HLA matching was an independent predictor for recurrent IgAN only in recipients of living-related but not deceased or living-unrelated transplants. Recurrent IgAN was an independent predictor of allograft failure, along with acute rejection. In patients with recurrent IgAN, serum creatinine at biopsy, degree of proteinuria, and concurrent acute rejection were associated with inferior allograft survival. Conclusion: Recurrent IgAN negatively affects allograft survival. Younger recipient age at transplantation is an independent predictor of recurrent IgAN, while the presence of HLAs associated with IgAN in the native kidney and HLA matching in recipients of deceased or living-unrelated transplants are not.",

keywords = "Human leukocyte antigen matching, IgA nephropathy, Kidney transplantation, Pathology, Recurrent disease",

author = "Kavanagh, {Catherine R.} and Francesca Zanoni and Rita Leal and Jain, {Namrata G.} and Stack, {Megan Nicole} and Vasilescu, {Elena Rodica} and Geo Serban and Carley Shaut and Jeanne Kamal and Satoru Kudose and Ant{\'o}nio Martinho and Rui Alves and Dominick Santoriello and Canetta, {Pietro A.} and David Cohen and Jai Radhakrishnan and Appel, {Gerald B.} and Stokes, {Michael B.} and Markowitz, {Glen S.} and D{\textquoteright}Agati, {Vivette D.} and Krzysztof Kiryluk and Andeen, {Nicole K.} and Ibrahim Batal",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s).",

year = "2022",

month = jan,

doi = "10.1159/000519834",

language = "English (US)",

volume = "2",

pages = "42--53",

journal = "Glomerular Diseases",

issn = "2673-3633",

publisher = "S. Karger AG",

number = "1",

}

TY - JOUR

T1 - Clinical Predictors and Prognosis of Recurrent IgA Nephropathy in the Kidney Allograft

AU - Kavanagh, Catherine R.

AU - Zanoni, Francesca

AU - Leal, Rita

AU - Jain, Namrata G.

AU - Stack, Megan Nicole

AU - Vasilescu, Elena Rodica

AU - Serban, Geo

AU - Shaut, Carley

AU - Kamal, Jeanne

AU - Kudose, Satoru

AU - Martinho, António

AU - Alves, Rui

AU - Santoriello, Dominick

AU - Canetta, Pietro A.

AU - Cohen, David

AU - Radhakrishnan, Jai

AU - Appel, Gerald B.

AU - Stokes, Michael B.

AU - Markowitz, Glen S.

AU - D’Agati, Vivette D.

AU - Kiryluk, Krzysztof

AU - Andeen, Nicole K.

AU - Batal, Ibrahim

PY - 2022/1

Y1 - 2022/1

N2 - Introduction: Although IgA nephropathy (IgAN) is the most common recurrent glomerulonephritis encountered in the kidney allograft, the clinical and immunogenetic characteristics remain poorly understood. We sought to study determinants and prognosis of recurrent IgAN with special focus on human leukocyte antigens (HLAs). Materials and Methods: Between 2005 and 2019, we identified 282 transplanted patients with failure secondary to IgAN from 2 North American and 1 European Medical Centers, including 80 with recurrent IgAN and 202 without recurrence. The prevalence of HLAs was compared to external healthy controls of European ancestry (n = 15,740). Graft survival was assessed by the Kaplan-Meier method and log rank test. Cox proportional hazards were used for multivariable analyses. Results: Compared to external controls of European ancestry, kidney transplant recipients of European ancestry with kidney failure secondary to IgAN had higher frequency of HLA-DQ5 (42% vs. 30%, OR = 1.68, p = 0.002) and lower frequency of HLA-DR15 (15% vs. 28%, OR = 0.46, p < 0.001) and HLA-DQ6 (32% vs. 45%, OR = 0.59, p = 0.003); however, the frequency of these HLAs were similar in recurrent versus nonrecurring IgAN. Younger recipient age at transplantation was an independent predictor of recurrence. HLA matching was an independent predictor for recurrent IgAN only in recipients of living-related but not deceased or living-unrelated transplants. Recurrent IgAN was an independent predictor of allograft failure, along with acute rejection. In patients with recurrent IgAN, serum creatinine at biopsy, degree of proteinuria, and concurrent acute rejection were associated with inferior allograft survival. Conclusion: Recurrent IgAN negatively affects allograft survival. Younger recipient age at transplantation is an independent predictor of recurrent IgAN, while the presence of HLAs associated with IgAN in the native kidney and HLA matching in recipients of deceased or living-unrelated transplants are not.

AB - Introduction: Although IgA nephropathy (IgAN) is the most common recurrent glomerulonephritis encountered in the kidney allograft, the clinical and immunogenetic characteristics remain poorly understood. We sought to study determinants and prognosis of recurrent IgAN with special focus on human leukocyte antigens (HLAs). Materials and Methods: Between 2005 and 2019, we identified 282 transplanted patients with failure secondary to IgAN from 2 North American and 1 European Medical Centers, including 80 with recurrent IgAN and 202 without recurrence. The prevalence of HLAs was compared to external healthy controls of European ancestry (n = 15,740). Graft survival was assessed by the Kaplan-Meier method and log rank test. Cox proportional hazards were used for multivariable analyses. Results: Compared to external controls of European ancestry, kidney transplant recipients of European ancestry with kidney failure secondary to IgAN had higher frequency of HLA-DQ5 (42% vs. 30%, OR = 1.68, p = 0.002) and lower frequency of HLA-DR15 (15% vs. 28%, OR = 0.46, p < 0.001) and HLA-DQ6 (32% vs. 45%, OR = 0.59, p = 0.003); however, the frequency of these HLAs were similar in recurrent versus nonrecurring IgAN. Younger recipient age at transplantation was an independent predictor of recurrence. HLA matching was an independent predictor for recurrent IgAN only in recipients of living-related but not deceased or living-unrelated transplants. Recurrent IgAN was an independent predictor of allograft failure, along with acute rejection. In patients with recurrent IgAN, serum creatinine at biopsy, degree of proteinuria, and concurrent acute rejection were associated with inferior allograft survival. Conclusion: Recurrent IgAN negatively affects allograft survival. Younger recipient age at transplantation is an independent predictor of recurrent IgAN, while the presence of HLAs associated with IgAN in the native kidney and HLA matching in recipients of deceased or living-unrelated transplants are not.

KW - Human leukocyte antigen matching

KW - IgA nephropathy

KW - Kidney transplantation

KW - Pathology

KW - Recurrent disease

UR - http://www.scopus.com/inward/record.url?scp=85124587107&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85124587107&partnerID=8YFLogxK

U2 - 10.1159/000519834

DO - 10.1159/000519834

M3 - Article

AN - SCOPUS:85124587107

SN - 2673-3633

VL - 2

SP - 42

EP - 53

JO - Glomerular Diseases

JF - Glomerular Diseases

IS - 1

ER -

Clinical Predictors and Prognosis of Recurrent IgA Nephropathy in the Kidney Allograft

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this