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      IgA Nephropathy Recurrence after Kidney Transplantation: Role of Recipient Age and Human Leukocyte Antigen-B Mismatch

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          Background: Recurrence of immunoglobulin (Ig)A nephropathy (rIgAN) is a growing cause of kidney allograft dysfunction. This study was aimed at investigating factors associated with rIgAN and the subsequent progression to end-stage renal disease (ESRD). Methods: Retrospective study including consecutive patients with IgA nephropathy (IgAN) who received a kidney transplant in our center between 1992 and 2016 and had a renal biopsy by clinical indication. The date of detection of chronic kidney disease (CKD) 5 was used as renal outcome. Results: Eighty-six kidney transplants were performed in patients with IgAN, 38 (44%) were from living donors (related n = 26). rIgAN was diagnosed in 23 allografts (27%). Renal function and proteinuria at the end of the follow-up period were worst in the rIgAN patients compared to those without rIgAN (2.2 vs. 1.4 mg/dL, p = 0.014, and 1.16 vs. 0.49 g/day, p = 0.005, respectively). Risk of rIgAN and progression to CKD 5 decreased with patient’s age (hazard ratio [HR] 0.95, 95% CI 0.92–0.98, p = 0.002, and HR 0.97, 95% CI 0.83–0.97, p = 0.008 per year, respectively). Patients with rIgAN had a higher risk of progression to CKD 5 (HR 6.7, 95% CI 1.3–35.7, p = 0.025). Full donor-recipient mismatch in the human leukocyte antigen (HLA)-B loci decreased the risk of rIgAN (HR 0.22, 95% CI 0.06–0.76, p = 0.017). Conclusions: rIgAN was an independent risk factor for ESRD after renal allograft. Younger age increased the risk of rIgAN and CKD 5. Conversely, HLA-B mismatching was a potential protective factor for rIgAN of this glomerular disease.

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          Author and article information

          Am J Nephrol
          American Journal of Nephrology
          S. Karger AG
          May 2020
          18 March 2020
          : 51
          : 5
          : 357-365
          aDepartment of Nephrology and Renal Transplantation, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
          bDepartment of Immunology, Hospital Clínic, Barcelona, Spain
          cDepartment of Pathology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
          dCentro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
          eInstitut d’Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
          Author notes
          *Lida M. Rodas, Department of Nephrology and Renal Transplantation, Hospital Clinic, Calle Villarroel 170, ES–08036 Barcelona (Spain), E-Mail
          506853 Am J Nephrol 2020;51:357–365
          © 2020 S. Karger AG, Basel

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          Page count
          Figures: 6, Tables: 3, Pages: 9
          Transplantation: Research Article


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