Recurrent diseases in the renal allograft

Although recurrent diseases in the renal transplant are becoming increasing recognized as graft survival continue to improve, they account for less than 2 to 4% of all allograft failures. The most frequent cause of recurrent disease is recurrent glomerulonephritis. Among the recurrent glomerulonephritides, type II membranoproliferative glomerulonephritis, immunoglobulin A nephropathy, and focal and segmental glomerulosclerosis have the highest rates of recurrence. The observation continues to be substantiated that recurrence rates are increased in recipients of living-related transplants, particularly in those whose original native kidney disease was focal and segmental glomerulosclerosis, immunoglobulin A nephropathy, membranous glomerulonephritis, Henoch-Schönlein purpura, or the hemolytic uremic syndrome. Additionally, although renal transplantation has been felt to be contraindicated in patients with Fabry's disease, more recent experience with improved patient survival and decreased morbidity would suggest that transplantation may be a viable alternative for this systemic illness.