Increased glomerulonephritis recurrence after living related donation

Area of Science:

• Nephrology
• Transplantation immunology
• Genetics

Background:

• Kidney transplantation offers better outcomes for end-stage kidney disease patients.
• Live donor kidneys generally yield superior results compared to deceased donor kidneys.
• Glomerulonephritis recurrence is a significant cause of allograft loss, often influenced by genetic factors.

Purpose of the Study:

• To investigate the impact of living related donation on glomerulonephritis recurrence rates and subsequent graft outcomes.
• To determine if genetic predisposition influences glomerulonephritis recurrence in kidney transplants from related donors.

Main Methods:

• Analysis of 7236 patient records from the ANZDATA transplant registry over 28 years.
• Utilized Kaplan-Meier survival analysis and Cox Proportional Hazards models for adjusted analyses.
• Employed a competing risk model to assess graft outcomes.

Main Results:

• Glomerulonephritis recurrence was significantly higher in living related donor grafts versus living unrelated or deceased donor grafts (p < 0.001).
• In IgA nephropathy, 10-year recurrence rates were 16.7% for living related donors vs. 7.1% for living unrelated and 9.2% for deceased donors.
• In focal segmental glomerulosclerosis, 10-year recurrence risk was 14.6% for living related donors vs. 6.6% for deceased donors.

Conclusions:

• A higher risk of glomerulonephritis recurrence was observed in IgA Nephropathy and Focal Segmental Glomerulosclerosis when using living related donors compared to deceased donors.
• These findings suggest a role for heritable kidney-intrinsic predisposition in glomerulonephritis recurrence after transplantation.