Initial Response to Immunosuppressive and Renoprotective Treatment in Posttransplant Glomerulonephritis

• Published in: Transplantation proceedings 2006-12, Vol.38 (10), p.3491-3497
• Main Authors: Carneiro-Roza, F., Medina-Pestana, J.O., Moscoso-Solorzano, G., Franco, M., Ozaki, K., Mastroianni-Kirsztajn, G.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Biological and medical sciences; Biopsy; Child; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Glomerulonephritis; Glomerulonephritis - immunology; Glomerulonephritis - pathology; Glomerulonephritis - prevention & control; Glomerulonephritis - surgery; Humans; Immunosuppressive Agents - classification; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Postoperative Complications - immunology; Postoperative Complications - prevention & control; Recurrence; Reoperation; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2006.10.109

The current studies on posttransplant glomerulonephritis (PTxGN) do not establish when, how, or how long we must treat these patients. This study sought to compare the initial response to immunosuppressive treatment and renoprotection in PTxGN. This prospective study was performed in 23 patients with a histological diagnosis of PTxGN. Mean follow-up was 12 months (3–18); 91% received immunosuppressants, and 56.5% just renoprotective drugs. The best results (reduction of serum creatinine [SCr] and proteinuria) with immunosuppression were observed in patients with recurrent membranous PTxGN using the scheme of Ponticelli (IV + PO corticosteroid [CS] + PO cyclophosphamide [CPP]). A similar response was also seen in subjects with recurrent or de novo focal glomerulosclerosis treated with PO CS or CPP, except when the initial SCr > 2.5 mg/dL. In de novo IgA nephropathy, reduction of proteinuria occurred with use of PO CS, with or without CPP, but without improvement in SCr. Patients with recurrent or de novo crescentic PTxGN used renoprotective drugs and always immunosuppressants. In this group, good results were seen with IV + PO CS, with or without CPP, when there was less than 50% of glomeruli with crescents, or more than 50% with crescents but an initial SCr < 2.5 mg/dL. Immunosuppression seemed to give a better initial response than renoprotection in cases of membranous, IgA, and focal segmental glomulerulosclerosis PTxGN. Patients with an initial SCr ≥ 2.5 mg/dL displayed worse outcomes.