Glomerular disease recurrence in second and subsequent kidney transplants.

Area of Science:

• Nephrology
• Transplantation immunology
• Glomerular disease research

Background:

• Primary glomerular diseases, including focal segmental glomerulosclerosis (FSGS), IgA nephropathy, and membrano-proliferative glomerulonephritis (MPGN), can recur post-renal transplant, leading to graft loss.
• The recurrence rate and outcomes of second renal transplants following first graft failure due to these diseases remain unclear.

Purpose of the Study:

• To investigate the outcomes of second renal transplants in patients whose first graft failed due to recurrent primary glomerular diseases.
• To determine if disease recurrence in a first renal allograft impacts the success of subsequent re-transplantation.

Main Methods:

• A retrospective analysis of the Irish transplant database (1982–2009) was conducted.
• Patients with biopsy-confirmed recurrent primary FSGS, IgA nephropathy, or MPGN causing first graft failure who received a second transplant were included.

Main Results:

• Out of 3,330 transplants, 33 patients underwent re-transplantation following first graft failure due to recurrent glomerular disease.
• Clinically significant recurrence was observed in 44% of these re-transplants by 10 years.
• Median survival for second grafts in this cohort was 9.1 years, compared to 10.5 years for all other re-transplants.

Conclusions:

• Clinically significant recurrence does not invariably compromise re-transplant outcomes.
• Selected patients experiencing first graft failure from recurrent glomerular disease should be considered candidates for a second renal transplant.