H- 15 : Recurrence of initial nephropathy
Primary disease recurrence—effects on paediatric renal transplantation
outcomes
Justine Bacchetta & Pierre Cochat
Journal : Nature Reviews Nephrology
Year : 2015 / Month : April
Volume : 11
Pages : 371–384
doi:10.1038/nrneph.2015.54
ABSTRACT
Primary disease recurrence after renal transplantation is mainly diagnosed by examination of biopsy
samples, but can also be associated with clinical symptoms. In some patients, recurrence can lead to
graft loss (7–8% of all graft losses). Primary disease recurrence is generally associated with a high
risk of graft loss in patients with focal segmental glomerulosclerosis, membranous proliferative
glomerulonephritis, primary hyperoxaluria or atypical haemolytic uraemic syndrome. By contrast,
disease recurrence is associated with a limited risk of graft loss in patients with IgA nephropathy,
renal involvement associated with Henoch–Schönlein purpura, antineutrophil cytoplasmic antibodyassociated glomerulonephritis or lupus nephritis. The presence of systemic diseases that affect the
kidneys, such as sickle cell anaemia and diabetes mellitus, also increases the risk of delayed graft
loss. This Review provides an overview of the epidemiology, pathophysiology and management of
primary disease recurrence in paediatric renal graft recipients, and describes the overall effect on
graft survival of each of the primary diseases listed above. With appropriate management, few
paediatric patients should be excluded from renal transplantation programmes because of an
increased risk of recurrence.
COMMENTS
Renal transplantation is the optimal form of renal replacement therapy (RRT) for children with endstage renal disease (ESRD). However, the primary disease can recur after renal transplantation.
Primary disease recurrence can be detected by pathological examination of renal biopsy samples, but
recurrence can also be associated with specific clinical findings. In some patients, recurrence of the
primary disease can lead to graft loss; indeed, recurrence accounts for 7–8% of all graft losses in
children, which is currently comparable to the rate of graft loss caused by acute rejection.
The following table from the review summarizes tha most frequent recurrences :
Many details and recommandations are given in the article and cannot be summarized adequately.
This review provides an update on the epidemiology, pathophysiology, effects and management of
disease recurrence after paediatric renal transplantation. Ppretransplantation and post-transplantation
risk-reduction strategies that aim to minimize the possibility of disease recurrence, and thus improve
both graft and patient outcomes are proposed.
Pr. Jacques CHANARD
Professor of Nephrology