Clinical Features, Treatment and Prognostic Factors of Post-Transplant Immunoglobulin A Nephropathy

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dc.citation.volumev. 23
dc.contributor.authorCabral, Diogo Buarque Cordeiro [UNIFESP]
dc.contributor.authorSandes-Freitas, Taina Veras de [UNIFESP]
dc.contributor.authorPestana, Jose Osmar Medina [UNIFESP]
dc.contributor.authorKirsztajn, Gianna Mastroianni [UNIFESP]
dc.coverageSmithtown
dc.date.accessioned2020-07-20T16:31:15Z
dc.date.available2020-07-20T16:31:15Z
dc.date.issued2018
dc.description.abstractBackground: 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.en
dc.description.affiliationFed Univ Sao Paulo UNIFESP, Nephrol Div, Glomerulopathies Sect, Sao Paulo, SP, Brazil
dc.description.affiliationFed Univ Sao Paulo UNIFESP, Nephrol Div, Transplantat Sect, Sao Paulo, SP, Brazil
dc.description.affiliationHosp Rim, Sao Paulo, SP, Brazil
dc.description.affiliationUnifespFed Univ Sao Paulo UNIFESP, Nephrol Div, Glomerulopathies Sect, Sao Paulo, SP, Brazil
dc.description.affiliationUnifespFed Univ Sao Paulo UNIFESP, Nephrol Div, Transplantat Sect, Sao Paulo, SP, Brazil
dc.description.sourceWeb of Science
dc.format.extent166-175
dc.identifierhttp://dx.doi.org/10.12659/AOT.907167
dc.identifier.citationAnnals Of Transplantation. Smithtown, v. 23, p. 166-175, 2018.
dc.identifier.doi10.12659/AOT.907167
dc.identifier.fileWOS000427524500001.pdf
dc.identifier.issn1425-9524
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/55825
dc.identifier.wosWOS:000427524500001
dc.language.isoeng
dc.publisherInt Scientific Literature, Inc
dc.relation.ispartofAnnals Of Transplantation
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectGlomerulonephritis, IgAen
dc.subjectImmunosuppressive Agentsen
dc.subjectKidney Transplantationen
dc.subjectPrognosisen
dc.titleClinical Features, Treatment and Prognostic Factors of Post-Transplant Immunoglobulin A Nephropathyen
dc.typeinfo:eu-repo/semantics/article
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