HDCN Article Review/Hyperlink

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)