Clinical Predictors and Prognosis of Recurrent IgA Nephropathy in the Kidney Allograft.
Clinical Predictors and Prognosis of Recurrent IgA Nephropathy in the Kidney Allograft.
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DOI：
10.1159/000519834
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发表时间：
2022-01
期刊：
影响因子：
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通讯作者：
Batal, Ibrahim
中科院分区：
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作者：
Kavanagh, Catherine R;Zanoni, Francesca;Leal, Rita;Jain, Namrata G;Stack, Megan Nicole;Vasilescu, Elena-Rodica;Serban, Geo;Shaut, Carley;Kamal, Jeanne;Kudose, Satoru;Martinho, Antonio;Alves, Rui;Santoriello, Dominick;Canetta, Pietro A;Cohen, David;Radhakrishnan, Jai;Appel, Gerald B;Stokes, Michael B;Markowitz, Glen S;D'Agati, Vivette D;Kiryluk, Krzysztof;Andeen, Nicole K;Batal, Ibrahim
虽然伊加肾病（IgAN）是最常见的复发性肾小球肾炎中遇到的肾移植，临床和免疫遗传学特征仍然知之甚少。我们试图研究复发性IgAN的决定因素和预后，特别关注人类白细胞抗原（HLA）。在2005年至2019年期间，我们从2个北美和1个欧洲医疗中心确定了282例继发于IgAN的移植失败患者，其中80例复发IgAN，202例无复发。将HLA的患病率与欧洲血统的外部健康对照（n = 15，740）进行比较。采用Kaplan-Meier法和对数秩检验评估移植物存活率。采用考克斯比例风险进行多变量分析。与欧洲血统的外部对照相比，继发于IgAN的肾衰竭的欧洲血统的肾移植受者具有更高的HLA-DQ 5频率，（42% vs. 30%，OR = 1.68，p = 0.002）和HLA-DR 15频率较低（15%对28%，OR = 0.46，p < 0.001）和HLA-DQ 6（32%对45%，OR = 0.59，p = 0.003）;然而，这些HLA的频率在复发性与非复发性IgAN中相似。移植时受体年龄较小是复发的独立预测因素。HLA配型仅在活体相关移植受者中是复发性IgAN的独立预测因子，而在死亡或非活体相关移植受者中则不是。复发性IgAN与急性排斥反应一起沿着是同种异体移植失败的独立预测因子。在复发性IgAN患者中，活检时血清肌酐、蛋白尿程度和并发急性排斥反应与移植物存活率低下相关。复发性IgAN对同种异体移植物存活率有负面影响。移植时受体年龄较小是IgAN复发的独立预测因素，而与IgAN相关的HLA在自体肾中的存在以及已故或活体无关移植受体的HLA匹配则不是。
Although IgA nephropathy (IgAN) is the most common recurrent glomerulonephritis encountered in the kidney allograft, the clinical and immunogenetic characteristics remain poorly understood. We sought to study determinants and prognosis of recurrent IgAN with special focus on human leukocyte antigens (HLAs). Between 2005 and 2019, we identified 282 transplanted patients with failure secondary to IgAN from 2 North American and 1 European Medical Centers, including 80 with recurrent IgAN and 202 without recurrence. The prevalence of HLAs was compared to external healthy controls of European ancestry (n = 15,740). Graft survival was assessed by the Kaplan-Meier method and log rank test. Cox proportional hazards were used for multivariable analyses. Compared to external controls of European ancestry, kidney transplant recipients of European ancestry with kidney failure secondary to IgAN had higher frequency of HLA-DQ5 (42% vs. 30%, OR = 1.68, p = 0.002) and lower frequency of HLA-DR15 (15% vs. 28%, OR = 0.46, p < 0.001) and HLA-DQ6 (32% vs. 45%, OR = 0.59, p = 0.003); however, the frequency of these HLAs were similar in recurrent versus nonrecurring IgAN. Younger recipient age at transplantation was an independent predictor of recurrence. HLA matching was an independent predictor for recurrent IgAN only in recipients of living-related but not deceased or living-unrelated transplants. Recurrent IgAN was an independent predictor of allograft failure, along with acute rejection. In patients with recurrent IgAN, serum creatinine at biopsy, degree of proteinuria, and concurrent acute rejection were associated with inferior allograft survival. Recurrent IgAN negatively affects allograft survival. Younger recipient age at transplantation is an independent predictor of recurrent IgAN, while the presence of HLAs associated with IgAN in the native kidney and HLA matching in recipients of deceased or living-unrelated transplants are not.