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Updated: Oct 9, 2026
Mouse Kidney Transplantation: Models of Allograft Rejection
Published on: October 11, 2014
Recurrent primary disease and de novo nephritis following renal transplantation
1Clinical Science Laboratories, Guy's Hospital, London, UK.
Insights
Recurrent and de novo diseases in pediatric kidney transplants, though rare, offer insights into graft failure mechanisms. Management strategies are evolving, especially for metabolic diseases like type I hyperoxaluria.
Area of Science:
- Nephrology
- Pediatric Transplantation
- Immunology
Background:
- Recurrent or de novo diseases represent a small fraction of pediatric graft failure but are crucial for understanding underlying mechanisms.
- Type I hyperoxaluria is a notable metabolic disease with high recurrence rates post-transplantation, necessitating combined or prophylactic liver-kidney transplantation.
- Various forms of nephritis can recur histologically in allografts, often with subclinical or mild clinical manifestations.
Purpose of the Study:
- To analyze the incidence and impact of recurrent and de novo diseases on pediatric kidney allograft outcomes.
- To identify specific diseases that frequently recur or develop de novo in pediatric kidney transplants.
- To discuss current management strategies and challenges associated with these conditions.
Main Methods:
- Review of pediatric kidney transplant cases with recurrent or de novo kidney diseases.
- Analysis of clinical presentation, histological findings, and graft outcomes.
- Comparison of recurrence rates and severity across different disease categories.
Main Results:
- Type I hyperoxaluria recurrence impacts long-term results, favoring combined liver-kidney or prophylactic liver transplantation.
- Mesangiocapillary glomerulonephritis type II, IgA nephropathy, and Henoch-Schönlein purpura may recur histologically but often with mild clinical impact.
- Focal segmental glomerulosclerosis, mesangiocapillary glomerulonephritis type I, and hemolytic-uremic syndromes recur frequently and severely, impacting donor choices.
- De novo membranous nephropathy occurs in up to 10% of pediatric grafts, usually mild.
- Anti-glomerular basement membrane nephritis in Alport syndrome can lead to graft failure but affects a minority of recipients.
Conclusions:
- Recurrent and de novo diseases, while uncommon, significantly influence pediatric kidney transplant success.
- Specific diseases like focal segmental glomerulosclerosis and type I mesangiocapillary glomerulonephritis pose substantial risks for recurrence.
- Risk factors for recurrence remain poorly understood, and effective treatments are limited, highlighting the need for further research.
Abstract:
Recurrent or de novo diseases account for only 5% of graft failure in children, but have much to teach us about mechanisms. In children, almost the only metabolic disease with recurrence is type I hyperoxaluria, in which the poor long-term results of isolated renal transplantation make combined liver and renal transplantation, or even prophylactic liver transplantation before renal failure the preferable alternatives. While many forms of nephritis may show histological recurrence in allografts, it is notable that in many patients this is accompanied by no clinical manifestations or only mild disease: this is particularly so in mesangiocapillary glomerulonephritis (MCGN) type II. IgA-associated nephropathy and Henoch-Schönlein purpura. However focal segmental glomerulosclerosis and MCGN type I recur with sufficient frequency and severity to deter the use of living donors unless there is no alternative. The same is true of haemolytic-uraemic syndromes. As many as 10% of paediatric grafts may show de novo membranous nephropathy, but in the majority this is mild or not clinically evident. In contrast, the rare anti-glomerular basement membrane nephritis affecting some patients with Alport's syndrome usually results in graft failure, but occurs in only a minority of recipients with the syndrome. For all types of disease in allografts, risk factors for recurrence are poorly worked out, and attempts at treatment generally ineffective.
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