The risk of recurrent I g A nephropathy in a steroid‐free protocol and other modifying immunosuppression

• Published in: Clinical transplantation 2014-08, Vol.28 (8), p.845-854
• Main Authors: Von Visger, J. R., Gunay, Y., Andreoni, K. A., Bhatt, U. Y., Nori, U. S., Pesavento, T. E., Elkhammas, E. A., Winters, H. A., Nadasdy, T., Singh, N.
• Format: Article
• Language: English
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12389

Recurrent glomerulonephritis is an important cause of kidney allograft failure. The effect of immunosuppression on recurrent IgA nephropathy (Ig AN ) is unclear. We analyzed the impact of steroids and other immunosuppression on the risk of recurrent Ig AN post‐kidney transplantation. Between June 1989 and November 2008, 3311 kidney transplants were performed at our center. Ig AN was the primary disease in 124 patients; of these, 75 (60.5%) patients received steroid‐based immunosuppression (15 undergoing late steroid withdrawal), and 49 (39.5%) were maintained on steroid‐free immunosuppression. Recurrent Ig AN was diagnosed in 27 of 124 (22%) patients in clinically indicated kidney allograft biopsies over a median follow‐up of 6.86 ± 5.4 yr. On cox proportional hazards model multivariate analysis, the hazard risk ( HR ) of Ig AN recurrence was significantly higher in patients managed with steroid‐free ( HR 8.59: 3.03, 24.38, p