Impact of Disease Recurrence and Outcomes following Kidney Transplantation for GN: A Prospective Nationwide Cohort...

GN is one of the main causes of kidney transplantation. In patients transplanted for GN, the risk of recurrence is approximately 16%. Recurrence significantly worsens the prognostic, tripling and doubling the risk of graft loss and acute rejection, respectively. Despite having more often received immunosuppression before transplantation, patients with GN are not at increased risk of post-transplantation cancers.

Patients who receive transplants after kidney failure due to GN (GN-KTx) constitute a significant portion of recipients and may face unique challenges post-transplantation, related to the risk of GN recurrence and a higher global burden of immunosuppression.

We analyzed patient and graft outcomes, including the risk of graft loss in relation to recurrence in GN-KTx, compared with patients transplanted for other causes, using data from the prospective nationwide Swiss Transplant Cohort Study.

Among 2631 included patients, 701 were GN-KTx, with IgA nephropathy being the most common GN subtype. GN-KTx recipients were younger and more likely to receive living donor organs. During a mean follow-up period of 5.3 years (interquartile range, 2.3-8.2), the 5-year cumulative incidence of graft loss was similar across groups, with GN-KTx at 6%. Notably, GN-KTx had a similar incidence of acute rejection as other groups. Recurrence occurred in 16% of GN-KTx within a mean time of 1.7 years (interquartile range, 0.28-2). Patients with recurrence faced a three-fold higher risk of graft loss. Furthermore, disease recurrence was associated with a two-fold higher risk of acute rejection compared with nonrecurrent GN-KTx. Interestingly, regarding cancer risks, GN-KTx patients had the lowest incidence of skin cancer and no higher risk of nonskin cancers, despite greater exposure to immunosuppression compared with other kidney transplant recipients.

These real-life setting contemporary multicenter data highlight the importance of post-transplant monitoring for GN recurrence, given the strong association with poor graft outcomes and higher rejection rates. This is important in the context of current development of targeted therapies for GN in native kidneys that could be transposed to transplanted kidneys.