Outcomes in Patients With Henoch-Schönlein Purpura After Kidney Transplantation: A Propensity Score Matched Study

Henoch-Schönlein purpura (HSP) nephritis leads to end-stage renal disease (ESRD) in upto 3% of cases, necessitating kidney transplantation (KT). This study compared graft and patient survival outcomes between HSP and non-HSP KT recipients and identified factors associated with HSP recurrence.

Data from the Scientific Registry of Transplant Recipients (SRTR) were analysed for adult and paediatric KT patients listed between January 2005 and April 2021. HSP recipients were extracted from the database and non-HSP recipients were selected and propensity-matched 3:1 based on demographic factors.

A total of 371 KT recipients with HSP were matched to 1113 non-HSP recipients. When stratified by age, adult and paediatric HSP patients showed similar death-censored graft survival (DCGS) at 5 years compared to their non-HSP counterparts. Furthermore, paediatric patients with HSP had comparable DCGS to adult HSP patients at 5 years (86.5% vs. 88.3%, p = 0.221). Amongst HSP recipients, 27.2% experienced recurrence, with higher rates in adults (29.7%) compared to children (13.0%). Recurrent HSP was associated with increased graft failure and mortality. Regression analysis showed that older age (OR [95% CI]: 1.018 (1.001-1.035), p = 0.037) was associated with a higher risk of recurrence, while a higher BMI (0.95 [0.91-0.99], p = 0.020) was linked to a lower risk.

In a contemporary cohort of HSP KT patients, graft survival was comparable between HSP and matched non-HSP patients in both adult and paediatric groups. However, graft loss was more frequent in HSP patients who experienced disease recurrence.