Recurrent diseases in the kidney transplant

Area of Science:

• Nephrology
• Transplantation Immunology
• Renal Pathology

Background:

• Most native kidney diseases recur in kidney transplants, except for a few like Alport syndrome and polycystic kidney disease.
• Disease recurrence post-transplantation typically has a minor clinical impact, contributing to only about 5% of graft loss.
• Certain primary renal diseases and systemic conditions pose a higher risk of recurrence in kidney allografts.

Purpose of the Study:

• To review the spectrum of native kidney diseases that recur after kidney transplantation.
• To assess the clinical significance and impact of recurrent diseases on kidney allograft survival.
• To provide guidance on transplantation strategies for patients with specific conditions known to recur.

Main Methods:

• Literature review of studies on kidney transplant outcomes and disease recurrence.
• Analysis of data on the incidence and impact of recurrent diseases on graft survival.
• Synthesis of current recommendations regarding transplantation in the context of recurrent renal pathologies.

Main Results:

• Commonly recurring primary renal diseases include IgA nephropathy, focal and segmental glomerulosclerosis, and membranoproliferative glomerulonephritis type II.
• Diabetic nephropathy is the most frequent systemic disease to recur in kidney transplants.
• Living-related transplantation requires caution in cases of hemolytic uremic syndrome, recurrent focal and segmental glomerulosclerosis, and membranous glomerulonephritis.

Conclusions:

• While most kidney diseases recur post-transplant, the overall impact on graft survival is limited.
• Specific recurrent diseases necessitate careful patient selection and consideration of donor type.
• Conditions like Fabry disease and primary hyperoxaluria type I are no longer absolute contraindications, expanding transplantation eligibility.