World Journal of Surgery

, Volume 36, Issue 12, pp 2923–2930

Impact of Posttransplantation Glomerulonephritis on Long-term Outcome of Kidney Transplants: Single-Center 20-Year Experience

  • Tung-Min Yu
  • Mei-Chin Wen
  • Ming-Ju Wu
  • Cheng-Hsu Chen
  • Chi-Hung Cheng
  • Chi-Yuan Li
  • Kuo-Hsiung Shu
Article

Abstract

Background

Successful renal transplantation has been performed in patients with end-stage renal disease and has been routine in patients with end-stage renal failure for more than two decades. Despite advances in the use of immunosuppressants, there has been only modest improvement in long-term allograft survival. Accumulating data have demonstrated that chronic rejection and recurrent glomerulonephritis are major causes of long-term allograft loss. However, data regarding the long-term impact of posttransplantation glomerulonephritis (PTGN) on ethnic Chinese populations are still unavailable.

Methods

From 1984 to 2010, a total of 268 patients who underwent renal allograft biopsies were reviewed retrospectively. Renal outcomes were compared by Kaplan–Meier analysis, and risk factors for renal survival and all-cause mortality were analyzed using the Cox proportional hazards model.

Results

In all, 85 patients (31.7 %) had PTGN, and the mean time of disease onset was 5.32 ± 5.18 years after transplantation. Among the 85 PTGN cases, 33 (39 %) were immunoglobulin A (IgA) nephropathy, 24 (28 %) were focal segmental glomerulosclerosis, and 8 (9.4 %) were membranous GN. Significant risk was associated with posttransplant IgA GN in hepatitis B virus carriers (odds ratio 5.371, 95 % confidence interval 1.68, 17.19; p = 0.0064). A total of 45 PTGN patients had allograft loss, of whom 49 % had IgA nephropathy. Patients with PTGN had inferior allograft survival rates compared to those with other pathologic findings (p < 0.0003).

Conclusions

Taken together, our results indicate that PTGN had a strong negative impact on long-term kidney graft survival. Posttransplant IgA nephropathy is a leading cause of allograft loss in Chinese kidney transplant patients with PTGN.

References

  1. 1.
    Hume DM, Merrill JP, Miller BF et al (1955) Experiences with renal homotransplantation in the human: report of nine cases. J Clin Invest 34:327–382PubMedCrossRefGoogle Scholar
  2. 2.
    Harrison JH, Merrill JP, Murray JE (1956) Renal homotransplantation in identical twins. Surg Forum 6:432–436PubMedGoogle Scholar
  3. 3.
    Murray JE, Merrill JP, Harrison JH (2001) Renal homotransplantation in identical twins: 1955. J Am Soc Nephrol 12:201–204PubMedGoogle Scholar
  4. 4.
    Yang H (2006) Maintenance immunosuppression regimens: conversion, minimization, withdrawal, and avoidance. Am J Kidney Dis 47:S37–S51PubMedCrossRefGoogle Scholar
  5. 5.
    Gaston RS (2006) Current and evolving immunosuppressive regimens in kidney transplantation. Am J Kidney Dis 47:S3–S21PubMedCrossRefGoogle Scholar
  6. 6.
    Matas AJ (2006) Recurrent disease after kidney transplantation: it is time to unite to address this problem! Am J Transplant 6:2527–2528PubMedCrossRefGoogle Scholar
  7. 7.
    Hariharan S, Johnson CP, Bresnahan BA et al (2000) Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med 342:605–612PubMedCrossRefGoogle Scholar
  8. 8.
    Hariharan S (2001) Long-term kidney transplant survival. Am J Kidney Dis 38:S44–S50PubMedCrossRefGoogle Scholar
  9. 9.
    Chadban S (2001) Glomerulonephritis recurrence in the renal graft. J Am Soc Nephrol 12:394–402PubMedGoogle Scholar
  10. 10.
    Choy BY, Chan TM, Lai KN (2006) Recurrent glomerulonephritis after kidney transplantation. Am J Transplant 6:2535–2542PubMedCrossRefGoogle Scholar
  11. 11.
    Briganti EM, Russ GR, McNeil JJ et al (2002) Risk of renal allograft loss from recurrent glomerulonephritis. N Engl J Med 347:103–109PubMedCrossRefGoogle Scholar
  12. 12.
    Hariharan S, Peddi VR, Savin VJ et al (1998) Recurrent and de novo renal diseases after renal transplantation: a report from the renal allograft disease registry. Am J Kidney Dis 31:928–931PubMedCrossRefGoogle Scholar
  13. 13.
    Ivanyi B (2008) A primer on recurrent and de novo glomerulonephritis in renal allografts. Nat Clin Pract Nephrol 4:446–457PubMedCrossRefGoogle Scholar
  14. 14.
    Gaston RS (2009) Chronic calcineurin inhibitor nephrotoxicity: reflections on an evolving paradigm. Clin J Am Soc Nephrol 4:2029–2034PubMedCrossRefGoogle Scholar
  15. 15.
    Ponticelli C, Villa M, Cesana B et al (2002) Risk factors for late kidney allograft failure. Kidney Int 62:1848–1854PubMedGoogle Scholar
  16. 16.
    Kaplan B (2006) Overcoming barriers to long-term graft survival. Am J Kidney Dis 4:S52–S64CrossRefGoogle Scholar
  17. 17.
    Hariharan S, Stablein DE (2005) Improvements in long-term renal transplant graft survival. Am J Transplant 5:630–631PubMedCrossRefGoogle Scholar
  18. 18.
    Morzycka M, Croker BP, Siegler HF et al (1982) Evaluation of recurrent glomerulonephritis in kidney allografts. Am J Med 72:588–598PubMedCrossRefGoogle Scholar
  19. 19.
    Eckhoff DE, Young CJ, Gaston RS et al (2007) Racial disparities in renal allograft survival: a public health issue? J Am Coll Surg 204:894–902PubMedCrossRefGoogle Scholar
  20. 20.
    Chailimpamontree W, Dmitrienko S, Li G et al (2009) Probability, predictors, and prognosis of posttransplantation glomerulonephritis. J Am Soc Nephrol 20:843–851PubMedCrossRefGoogle Scholar
  21. 21.
    Racusen LC, Solez K, Colvin RB et al (1999) The Banff 97 working classification of renal allograft pathology. Kidney Int 55:713–723PubMedCrossRefGoogle Scholar
  22. 22.
    Solez K, Colvin RB, Racusen LC et al (2008) Banff 07 classification of renal allograft pathology: updates and future directions. Am J Transplant 8:753–760PubMedCrossRefGoogle Scholar
  23. 23.
    Golgert WA, Appel GB, Hariharan S (2008) Recurrent glomerulonephritis after renal transplantation: an unsolved problem. Clin J Am Soc Nephrol 3:800–807PubMedCrossRefGoogle Scholar
  24. 24.
    Lai KN, Li PK, Lui SF et al (1991) Membranous nephropathy related to hepatitis B virus in adults. N Engl J Med 324:1457–1463PubMedCrossRefGoogle Scholar
  25. 25.
    Levy M, Chen N (1991) Worldwide perspective of hepatitis B-associated glomerulonephritis in the 80 s. Kidney Int Suppl 35:S24–S33PubMedGoogle Scholar
  26. 26.
    Lin CY (1991) Clinical features and natural course of HBV-related glomerulopathy in children. Kidney Int Suppl 35:S46–S53PubMedGoogle Scholar
  27. 27.
    Lai KN, Ho RT, Tam JS et al (1996) Detection of hepatitis B virus DNA and RNA in kidneys of HBV related glomerulonephritis. Kidney Int 50:1965–1977PubMedCrossRefGoogle Scholar
  28. 28.
    Lai FM, Lai KN, Tam JS et al (1994) Primary glomerulonephritis with detectable glomerular hepatitis B virus antigens. Am J Surg Pathol 18:175–186PubMedCrossRefGoogle Scholar
  29. 29.
    Takeda S, Kida H, Katagiri M et al (1988) Characteristics of glomerular lesions in hepatitis B virus infection. Am J Kidney Dis 11:57–62PubMedGoogle Scholar
  30. 30.
    Ponticelli C, Traversi L, Feliciani A et al (2001) Kidney transplantation in patients with IgA mesangial glomerulonephritis. Kidney Int 60:1948–1954PubMedCrossRefGoogle Scholar
  31. 31.
    Ponticelli C, Traversi L, Banfi G (2004) Renal transplantation in patients with IgA mesangial glomerulonephritis. Pediatr Transplant 8:334–338PubMedCrossRefGoogle Scholar
  32. 32.
    Ponticelli C, Glassock RJ (2010) Posttransplant recurrence of primary glomerulonephritis. Clin J Am Soc Nephrol 5:2363–2372PubMedCrossRefGoogle Scholar
  33. 33.
    Wang AY, Lai FM, Yu AW et al (2001) Recurrent IgA nephropathy in renal transplant allografts. Am J Kidney Dis 38:588–596PubMedCrossRefGoogle Scholar
  34. 34.
    Chan TM, Fang GX, Tang CS et al (2002) Preemptive lamivudine therapy based on HBV DNA level in HBsAg-positive kidney allograft recipients. Hepatology 36:1246–1252PubMedCrossRefGoogle Scholar
  35. 35.
    Lee WC, Wu MJ, Cheng CH et al (2001) Lamivudine is effective for the treatment of reactivation of hepatitis B virus and fulminant hepatic failure in renal transplant recipients. Am J Kidney Dis 38:1074–1081PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Tung-Min Yu
    • 1
    • 3
  • Mei-Chin Wen
    • 2
  • Ming-Ju Wu
    • 1
  • Cheng-Hsu Chen
    • 1
  • Chi-Hung Cheng
    • 1
  • Chi-Yuan Li
    • 3
  • Kuo-Hsiung Shu
    • 1
    • 4
  1. 1.Division of Nephrology, Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
  2. 2.Department of PathologyTaichung Veteran General HospitalTaichungTaiwan
  3. 3.Graduate Institute of Clinical Medical ScienceChina Medical UniversityTaichungTaiwan
  4. 4.Chung-Shan Medical UniversityTaichungTaiwan

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