Abstract
Background
IgA vasculitis, a rare condition resulting in end-stage renal disease, is a small-vessel vasculitis that affects the kidney in 49–83 % of adults. The reported recurrence rate of IgA vasculitis in renal transplant recipients is 11.5–60 %, leading to graft loss in 0–50 % of these patients. However, limited data are available on recurrence and graft loss after renal transplantation.
Methods
We evaluated renal transplant recipients seen from 1987 to 2015 at the Jikei University School of Medicine and the Department of Urology, Tokyo Women’s Medical University. Using a 1:2 match, 21 patients with IgA vasculitis and 42 controls were selected. The mean post-transplant follow-up was 121 ± 69 months for IgA vasculitis and 147 ± 66 months for the controls.
Results
The 15-year patient survival was 100 % in IgA vasculitis and 97.6 % in the controls (p = 0.22). The 5-, 10-, and 15-year graft survival rates were 95.2, 90.5, and 81 % in IgA vasculitis and 100, 90.5, and 88.1 % in the controls, respectively (p = 0.63). The recurrence rate was 28.6 % (6 of 21 cases) and half of them (3 of 6 cases) showed histological activity (ISKDC III). We treated them with methylprednisolone pulse therapy and/or tonsillectomy. None of the recurrence cases lost the allograft.
Conclusion
The long-term patient and graft survival of IgA vasculitis in renal transplantation were comparable with the previous reports. The recurrence rate was 28.6 %, but none of the recurrent cases showed allograft loss in this study. We speculate that methylprednisolone pulse therapy and/or tonsillectomy prevent the progression of recurrent IgA vasculitis.
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Acknowledgments
We appreciate the support provided by Katsunori Shimada, PhD. (STATZ Institute, Inc., Tokyo, Japan), who provided expert assistance with statistical analysis.
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None of the authors have any of conflicts of interest to declare with regard to the content of this article.
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Astellas Pharma Inc. (Tokyo, Japan) supported this study with a grant. The sponsor was not involved in the study design, patient enrollment, data collection, analysis, or interpretation, or preparation of the manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB Approval Number 28-003) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Kawabe, M., Yamamoto, I., Komatsuzaki, Y. et al. Recurrence and graft loss after renal transplantation in adults with IgA vasculitis. Clin Exp Nephrol 21, 714–720 (2017). https://doi.org/10.1007/s10157-016-1336-y
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DOI: https://doi.org/10.1007/s10157-016-1336-y