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Probability, Predictors, and Prognosis of Posttransplantation Glomerulonephritis

Worawon Chailimpamontree^*, Svetlana Dmitrienko^*,, Guiyun Li^*, Robert Balshaw^*,, Alexander Magil, R. Jean Shapiro^*, David Landsberg^*, John Gill^*, Paul A. Keown^*, and the Genome Canada Biomarkers in Transplantation Group

^* Division of Nephrology, Departments of Medicine, and Immunology and Anatomical Pathology, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada

Correspondence: Dr. Paul A. Keown, Division of Nephrology, 5th floor, Diamond Health Care Centre, 2775 Laurel Street, Vancouver, V5Z 1M9, British Columbia, Canada. Phone: 604-875-5950; Fax: 604-875-5598; E-mail: keown{at}interchange.ubc.ca

Received for publication May 4, 2008. Accepted for publication October 24, 2008.

Glomerulonephritis (GN) is the leading cause of chronic kidney disease among recipients of renal transplants. Because modern immunosuppressive regimens have reduced the incidence of rejection-related graft loss, the probability and clinical significance of posttransplantation GN (PTGN) requires reevaluation. In this Canadian epidemiologic study, we monitored 2026 sequential renal transplant recipients whose original renal disease resulted from biopsy-proven GN (36%), from presumed GN (7.8%), or from disorders other than GN (56%) for 15 yr without loss to follow-up. Kaplan-Meier estimates of PTGN in the whole population were 5.5% at 5 yr, 10.1% at 10 yr, and 15.7% at 15 yr. PTGN was diagnosed in 24.3% of patients whose original renal disease resulted from biopsy-proven GN, compared with 11.8% of those with presumed GN and 10.5% of those with disorders other than GN. Biopsy-proven GN in the native kidney, male gender, younger age, and nonwhite ethnicity predicted PTGN. Current immunosuppressive regimens did not associate with a reduced frequency of PTGN. Patients who developed PTGN had significantly reduced graft survival (10.2 versus 69.7%; P < 0.0001). In summary, in the Canadian population, PTGN is a common and serious complication that causes accelerated graft failure, despite the use of modern immunosuppressive regimens.

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J. Am. Soc. Nephrol. 2009 20: A12. [Full Text] [PDF]

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673