Mb. Andresdottir et al., The impact of recurrent glomerulonephritis on graft survival in recipientsof human histocompatibility leucocyte antigen-identical living related donor grafts, TRANSPLANT, 68(5), 1999, pp. 623-627
Background, Graft loss due to rejection is uncommon after human histocompat
ibility leukocyte antigen-identical living related donor (LRD) transplantat
ion, resulting in an excellent long-term graft survival. Data on the impact
of recurrence of the original disease on graft survival after LRD transpla
ntation are scarce.
Methods,We have studied the influence of recurrent glomerulonephritis in ad
ult recipients of a human histocompatibility leukocyte antigen-identical LR
D graft transplanted in our center in the period from 1968 to 1996, To that
end, the data of 33 patients with proven or suspected primary glomerulonep
hritis and 27 patients with nonglomerular diseases were analyzed.
Results,The patient survival was similar in both groups at 5, 10, and 20 ye
ars, The functional graft survival, i.e., graft survival after censoring fo
r death, was, however, significantly worse for patients with glomerulonephr
itis as underlying disease (P<0.01). At 5 years graft survival was 100% vs.
88%, at 10 years 100% vs. 70%, and at 20 years 100% vs. 63%, respectively.
Thus none of the patients with nonglomerular diseases lost a graft, wherea
s eight grafts were lost in the group of patients with glomerulonephritis,
The main cause of graft loss in this patient group was recurrent glomerulon
ephritis (n=5), whereas chronic vascular rejection caused graft loss in two
patients and occlusion of a transplant artery was the cause in one. A clin
ically significant proteinuria was detected in six more patients in the glo
merulonephritis group: a recurrent glomerulonephritis was diagnosed in four
patients and in two patients there was no biopsy, The cumulative incidence
of recurrence was as high as 45% at 12 years after transplantation.
Conclusion. Recipients of a human histocompatibility leukocyte antigen-iden
tical LRD kidney have a good prognosis with respect to graft survival, Afte
r censoring for death, recurrent glomerulonephritis is the main cause of gr
aft failure in these patients and the impact of recurrent disease on graft
survival will become even more prominent with longer follow-up.