Long-term Kidney Transplant Outcomes in Primary Glomerulonephritis: Analysis From the ERA-EDTA Registry

Maria Pippias, Vianda S Stel, Nuria Aresté-Fosalba, Cécile Couchoud, Gema Fernandez-Fresnedo, Patrik Finne, James G Heaf, Andries Hoitsma, Johan De Meester, Runolfur Pálsson, Pietro Ravani, Mårten Segelmark, Jamie P Traynor, Anna V Reisæter, Fergus J Caskey, Kitty J Jager

Research output: Contribution to journalArticle (Academic Journal)

Abstract

BACKGROUND: We evaluated the 15-year kidney allograft survival in patients with primary glomerulonephritis and determined if the risk of graft loss varied with donor source within each glomerulonephritis group.

METHODS: Using data from the European Renal Association-European Dialysis and Transplant Association Registry, Kaplan-Meier, competing risk, and Cox regression analyses were performed on adult, first kidney transplant recipients during 1991 to 2010 (n = 14 383). Follow-up was set to December 31, 2011. Adjustments for pretransplant dialysis duration, sex, country, and transplant era were made. "Death-adjusted graft survival" was assessed in patients with glomerulonephritis and compared with those with autosomal dominant polycystic kidney disease (ADPKD), in which the native kidney disease cannot recur. Additionally, death-adjusted graft survival was compared between living and deceased donor transplants within each glomerulonephritis group.

RESULTS: All glomerulonephritides had a 15-year death-adjusted graft survival probability above 55%. The 15-year risk of death-adjusted graft failure compared to ADPKD ranged from 1.17 (95% confidence interval [95% CI], 1.05-1.31) for immunoglobulin A nephropathy to 2.09 (95% CI, 1.56-2.78) for membranoproliferative glomerulonephritis type II. The expected survival benefits of living over deceased donor transplants were not present in membranoproliferative glomerulonephritis type I (adjusted hazard ratios [HRa], 1.08; 95% CI, 0.73-1.60) or type II (HRa, 0.90; 95% CI, 0.32-2.52) but present in immunoglobulin A nephropathy (HRa, 0.74; 95% CI, 0.59-0.92), membranous nephropathy (HRa, 0.47; 95% CI, 0.29-0.75), and focal segmental glomerulosclerosis (HRa, 0.69; 95% CI, 0.45-1.06).

CONCLUSIONS: This large European study shows favorable long-term kidney graft survival in all primary glomerulonephritides, although this remains lower than graft survival in ADPKD, and confirms that the reluctance to use living donors in some primary glomerulonephritides remains unfounded. These data will further inform prospective renal transplant recipients and donors during pretransplant counselling.

Original languageEnglish
Pages (from-to)1955-62
Number of pages8
JournalTransplantation
Volume100
Issue number9
DOIs
Publication statusPublished - 1 Sep 2016

Keywords

  • Adult
  • Allografts
  • Europe
  • Female
  • Glomerulonephritis/diagnosis
  • Graft Survival
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Transplantation/adverse effects
  • Living Donors
  • Male
  • Middle Aged
  • Polycystic Kidney, Autosomal Dominant/diagnosis
  • Proportional Hazards Models
  • Recurrence
  • Registries
  • Risk Factors
  • Time Factors
  • Treatment Outcome

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