The long-term outcome of renal transplantation of IgA nephropathy and the impact of recurrence on graft survival
The long-term outcome of renal transplantation of IgA nephropathy and the impact of recurrence on graft survival
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DOI：
10.1093/ndt/gfs472
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发表时间：
2013-05-01
影响因子：
6.1
通讯作者：
Messa, Piergiorgio
中科院分区：
文献类型：
--
作者：
Moroni, Gabriella;Longhi, Selena;Messa, Piergiorgio
关于伊加肾病（IgAN）肾移植患者15年时的移植物存活率、原发病复发的影响和预测因素的数据很少。在这项回顾性研究中，我们比较了190例IgAN患者和380例非糖尿病对照者的肾移植长期结局，并评估了IgAN复发对移植物结局的影响。在15年时，IgAN患者的患者生存率为88.3，对照组为82.6（P 0.12），而死亡删失的移植物生存率分别为62.6和72.4（P 0.038）。即使将死亡视为竞争风险，IgAN的移植失败累积发生率也高于对照组（P 0.025）。在多变量分析中，IgAN [相对危险度（RR）1.468，P 0.026]、移植物功能恢复延迟（RR 2.394，P 0.000）和急性排斥反应（RR 2.51，P = 0.000）可预测移植物丢失。IgAN复发42例（22.1%），其中12例因复发而失访，6例因复发而失访。非复发患者和复发患者的15年死亡删失移植物存活率分别为68.3和51.2（P 0.069）。非复发性IgAN患者的纯移植物存活率与对照组相似（P 0.406）。在考克斯分析中，IgAN的复发率从1981年到2010年显著降低（P 0.0065，RR 0.936）。IgAN成为长期移植物预后不良的独立预测因子。IgAN的复发似乎在1981年至2010年进行的移植中逐渐减少。
Few data are available on allograft survival at 15 years, the impact and the predictors of recurrence of the original disease in renal transplanted patients with IgA nephropathy (IgAN).In this retrospective study, we compared the long-term outcome of renal transplant in 190 patients with IgAN with that of 380 non-diabetic controls and evaluated the impact of recurrence of IgAN on the graft outcome.At 15 years, the patient survival was 88.3 in IgAN patients and 82.6 in controls (P 0.12), while the death-censored graft survival was 62.6 and 72.4, respectively (P 0.038). IgAN had a higher cumulative incidence of graft failures in comparison with controls even considering death as a competing risk (P 0.025). At multivariate analysis, IgAN [relative risk (RR) 1.468, P 0.026], delayed graft function recovery (RR 2.394, P 0.000) and acute rejection (RR 2.51, P = 0.000) were predictive of graft loss. IgAN recurred in 42 grafts (22.1), of them, 12 were lost for recurrence and in another 6 recurrence was considered a concomitant cause of graft loss. The 15-year death censored graft survival was 68.3 in non-recurrent and 51.2 in recurrent patients (P 0.069). Pure graft survival of non-recurrent IgAN patients was similar to that of controls (P 0.406). At Cox analysis, the recurrence of IgAN significantly reduced from 1981 to 2010 (P 0.0065, RR 0.936).IgAN emerged as an independent predictor of worse graft outcome in the long-term. Recurrence of IgAN seems to progressively reduce in transplants performed from 1981 to 2010.