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Article Review/Hyperlink
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Kessler M, Hiesse C, Hestin D, Mayeux D, Boubenider K,
Charpentier B
Recurrence of IgA nephropathy after renal
transplantation in the cyclosporine era
Am J Kidney Dis
(Jul) 28:99-104 1996

It commonly accepted that recurrent IgA nephropathy in a renal
allograft is not unusual in the histopathologic sense, and that graft
loss or severe dysfunction as a result of recurrent IgA deposition is
a rare entity. Unfortunately, the number of patients studied in
a systematic fashion remains small.
In their retrospective analysis, Kessler and colleagues attempt to
evaluate the clinical course of 84 renal transplant recipients with a
primary diagnosis of IgA nephropathy (or Henoch-Schonlein purpura).
Fifty of these patients developed graft dysfunction or abnormal
urinalysis and underwent percutaneous renal transplant biopsy. For
reasons unclear to the reader, only 28 of these patients were studied
with immunofluorescence. All patients received prophylactic therapy
with ALG or ATG but maintenance immunosuppression included
prednisone/cyclosporin (CSA)/azathioprine in some patients and
prednisone/CSA in others (patients not specified). The conclusion was
that CSA did not reduce the incidence or alter the severity of IgA
recurrence.
Comment: The strength of the conclusion re CSA is limited by
the small number of patients studied and thus this paper probably does
not make a major contribution to the literature. It is interesting to
note that 21% (6/11) of recipients with IF-proven IgA recurrence
followed greater than 5 years developed severe allograft dysfunction
or graft loss, but again, the total numbers are not ideal and follow
up needs to be extended. As the authors point out, it is possible that
immunosuppression may not even alter the course of the recurrent
disease when compared to the natural history of the initial disease.
Also, there is some suggestion in the literature that patients with
the primary renal diagnosis of IgA nephropathy who undergo a
living-related transplant (LRT) may be at higher risk for recurrent
disease. It would be interesting to know the clinical course of the 9
individuals who indeed underwent LRT.
(Mitch A. Vernace MD, North Shore University Hospital,
Manhassett, NY)
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