What is the role of renal transplantation in the treatment of immunoglobulin A (IgA) neuropathy?

Updated: May 19, 2020
  • Author: Sohail Abdul Salim, MD, FASN, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Kidney transplantation is effective in patients with IgA nephropathy, but the disorder frequently recurs after transplantation (20-60%). The higher recurrence rates in transplantation from living related donors suggest genetic susceptibility to the disease and high risk especially is disease is aggressive with cresents and treatment can be very difficult. [52]  

Some patients with post-transplantation IgA nephropathy present with microscopic hematuria and proteinuria, while others have only positive histologic findings. The disease usually progresses slowly, similarly to the disease in the native kidneys, and graft loss due to recurrent disease occurs in fewer than 10% of patients. There is little evidence that any specific immunosuppressive regimen decreases recurrence, but analysis of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) suggests increased risk with steroid withdrawal. [53]

Baek et al have reported reasonably good long-term results in patients receiving a second kidney transplant for IgA nephropathy. Recurrent disease was identified in only 2 of 28 patients during follow-up of 61.61 ± 47.23 months. [54]

 


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