肾移植后IgA肾病(IgAN)的复发发生在约30%的患者中。复发与移植物长期存活的相关性预计会增加,由于移植物的存活率不断提高。
在瑞士移植队列研究的嵌套研究中,IgAN复发的发生率,预测因素,评估移植物功能和移植物和患者存活率。血清总IgA浓度,总IgG,使用基于ELISA的免疫测定来测量Gd-IgA1和IgA-IgG免疫复合物。
2008年5月至2016年12月,瑞士有28名女性和133名男性因IgAN导致的终末期肾病接受了同种异体肾移植。移植后的中位随访时间为7年,161例患者中有43例(26.7%)出现IgAN复发,其中6例(13.9%)术后同种异体移植失败,另外4例(9.3%)死亡.在同一随访期间,118例患者中有6例(5%)均经历了同种异体移植失败或死亡而没有先前的IgAN复发。11年后,IgAN复发的风险为27.7%(95%-CI:20.6-35.3%)。移植后7年内有或没有复发的患者的肾功能相似,但此后复发患者(eGFR中位数(四分位数范围)在8年:49ml/min/1.73m2(29-68)与60ml/min/1.73m2(38-78))。血清总IgA浓度,总IgG,移植后第一年内的Gd-IgA1和IgA-IgG免疫复合物对IgAN的复发没有显着影响。年轻的接受者和女性有更高的复发风险,但后者仅在短期内。
我们的研究表明,移植后11年的复发风险为28%,这与以前的文献是一致的。然而,已知生物标志物的预测价值,如血清Gd-IgA1和IgA-IgGIC,IgAN复发无法证实.
Recurrence of IgA nephropathy (IgAN) after kidney transplantation occurs in about 30% of patients. The relevance of recurrence for the long-term graft survival is expected to increase, since graft survival continues to improve.
In a nested
study within the Swiss Transplant Cohort
Study the incidence of IgAN recurrence, predictive factors, graft function and graft and patient survival were evaluated. Serum concentration of total IgA, total IgG, Gd-IgA1 and IgA-IgG immune complex were measured using ELISA-based immunologic assays.
Between May 2008 and December 2016, 28 women and 133 men received their kidney allograft for end-stage kidney disease due to IgAN in Switzerland. Over a median follow-up time of 7 years after transplantation, 43 out of 161 patients (26.7%) developed an IgAN recurrence, of which six (13.9%) had an allograft failure afterwards and further four patients (9.3%) died. During the same follow-up period, 6 out of 118 patients (5%) each experienced allograft failure or died without prior IgAN recurrence. After 11 years the risk for IgAN recurrence was 27.7% (95%-CI: 20.6-35.3%). Renal function was similar in patients with and without recurrence up to 7 years after transplantation, but worsened thereafter in patients with recurrence (eGFR median (interquartile range) at 8 years: 49 ml/min/1.73m2 (29-68) vs. 60 ml/min/1.73m2 (38-78)). Serum concentration of total IgA, total IgG, Gd-IgA1 and IgA-IgG immune complex within the first year posttransplant showed no significant effect on the recurrence of IgAN. Younger recipients and women had a higher risk of recurrence, but the latter only in the short term.
Our
study showed a recurrence risk of 28% at 11 years after transplantation, which is consistent with previous literature. However, the predictive value of known biomarkers, such as serum Gd-IgA1 and IgA-IgG IC, for IgAN recurrence could not be confirmed.