Clinical Features, Treatment and Prognostic Factors of Post-Transplant Immunoglobulin A Nephropathy
Data
2018
Autores
Cabral, Diogo Buarque Cordeiro 
Sandes-Freitas, Taina Veras de
Pestana, Jose Osmar Medina
Kirsztajn, Gianna Mastroianni
Tipo
Artigo
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Background: Initially described as a relatively benign condition, recent studies report graft loss in up to 50% of the patients with post-transplant IgA nephropathy. There is no evidence for the best therapeutic approach, and prognostic factors remain to be elucidated. Material/Methods: Single center retrospective analysis of patients >12 years old, with clinically relevant post-transplant IgA nephropathy (proteinuria >= 1.0g/g and/or graft dysfunction) and >= 6 months follow-up after diagnosis (n=47). Results: Living donor transplants represented 85% of cases. Dysmorphic hematuria (100%), blood pressure elevation (95.7%), renal dysfunction (70.2%) and subnephrotic proteinuria (60.6%) predominated at presentation. Using the Oxford Classification, mesangial proliferation was the main histological lesion (91%). Treatment consisted mostly of blockade of the renin angiotensin system (89.4%) and modification of immunosuppression (85.1%), mainly by increasing oral steroids dose (83%), with venous pulse therapy in 63.8% of cases. Partial and complete remission occurred in 48.9% and 17% of cases, respectively. One patient died (sepsis) and 15 patients (31.9%) lost their grafts due to nephropathy. The percentage of decrease in glomerular filtration rate at diagnosis was independently associated with partial remission (HR 0.97, 95% CI 0.94-0.99, p=0.01) and graft loss (HR 1.13, 95% CI 1.06-1.20, p<0.001). Deceased donor (HR 28.04, 95% CI 4.41-178.39, p<0.001) and donor age (HR 1.1, 95% CI 1.04-1.16, p=0.001) were also risk factors for graft loss. Conclusions: Despite treatment, most patients with post-transplant IgA nephropathy in this cohort study presented unfavorable outcomes, and graft dysfunction at diagnosis appeared to be the main prognostic marker.
Descrição
Citação
Annals Of Transplantation. Smithtown, v. 23, p. 166-175, 2018.