P235
Allograft survival after transplantation for IgA nephropathy or Focal Segmental
Glomerulosclerosis: risks of recurrence.
Karim A, Bentall A, Metsini A, Neil D, Chatzitolios A, Hewins P, Lipkin G
Department of Renal Medicine, Queen Elizabeth Hospital Birmingham
Department of Pathology, Queen Elizabeth Hospital Birmingham
INTRODUCTION: Transplantation improves patient outcomes; however, recurrence of
primary glomerulonephritis may impact upon allograft survival. The aim of this
retrospective study was to analyze patient and allograft survival, categorized for
recurrent IgA nephropathy (IgAN) or FSGS.
METHODS: We identified renal transplants (n=1357) performed at a single centre
between 2001 and 2013 with available follow up data. Post transplant biopsies were
performed at the discretion of treating clinician for allograft dysfunction and/or
proteinuria. All post transplant biopsy reports were reviewed to identify recurrent
glomerulonephritis . For all transplant recipients, primary renal diagnosis was analysed
and non-immune mediated diseases were identified as a control cohort.
RESULTS: At 5 years , overall patient survival was 91.5% and allograft survival 83.7%
with median follow up of 1461 days (Q1-Q3 678-2554).The cause of ESRD was FSGS
in 3.7% (n=51) and IgAN in 11.4 % ( n=155) of patients transplanted. Biopsy proven
recurrent GN occurred in 15/155 (9.7%) of patients with IgAN and 5/51 (9.8%) of
patients with FSGS. Mean age of recipients with recurrence was 43.1 ± 12.3 vs. 45.0 ±
13.9 in the non-recurrent (p=0.41). Five-year allograft survival in patients with recurrent
IgAN was 42.9% and in recurrent FSGS was 25%. IgAN and FSGS patients without
recurrent disease had 5-year allograft survival rates of 80.4% and 83.4% respectively
(Figure 1). In the control cohort of ESRD due to non-immune mediated disease,
allograft survival at 5 years was 85.4%.
Figure 1: Death Censored Allograft Survival without GN recurrence (A) and time to
recurrence (B) for in IgA (green); FSGS (blue) transplants and control (red).
CONCLUSION: Patients without recurrent FSGS had similar 5-year allograft survival to
patients in the control cohort. Patients with biopsy proven recurrent IgAN and FSGS,
however, had poor 5 year allograft survival rates. Recurrence was earlier in FSGS. It
would be clinically useful to identify markers that predict recurrent IgAN and FSGS.