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

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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.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 160 Chung-Kang Road, Section 3, Taichung, Taiwan

    Tung-Min Yu, Ming-Ju Wu, Cheng-Hsu Chen, Chi-Hung Cheng & Kuo-Hsiung Shu

  2. Department of Pathology, Taichung Veteran General Hospital, Taichung, Taiwan

    Mei-Chin Wen

  3. Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan

    Tung-Min Yu & Chi-Yuan Li

  4. Chung-Shan Medical University, Taichung, Taiwan

    Kuo-Hsiung Shu

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  1. Tung-Min Yu
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  2. Mei-Chin Wen
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  3. Ming-Ju Wu
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Correspondence to Tung-Min Yu.

Additional information

Kuo-Hsiung Shu and Chi-Yuan Li have equal contribution to this work.

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Yu, TM., Wen, MC., Wu, MJ. et al. Impact of Posttransplantation Glomerulonephritis on Long-term Outcome of Kidney Transplants: Single-Center 20-Year Experience. World J Surg 36, 2923–2930 (2012). https://doi.org/10.1007/s00268-012-1759-x

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  • DOI: https://doi.org/10.1007/s00268-012-1759-x

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