Literary Highlights

With each newsletter, we plan to have an IPTA member highlight important recent publications in an area of general interest. Since all our members have access to our journal PEDIATRIC TRANSPLANTATION, this feature will highlight reports, from other journals, which may not be readily available to all our members. As with this inaugural edition, reports of adult data that may have relevance to our members may also be included.This newsletters’ literary highlights come from Sharon Bartosh, M.D., Chief, Pediatric Nephrology, American Family Children’s Hospital, University of Wisconsin.

  1. Allen PJ et al. Recurrent glomerulonephritis after kidney transplantation: risk factors and allograft outcomes. Kidney International; 92: 461-469, 2017.
    1. Data from the ANZDATA Australian and New Zealand registry of over 6,000 adult patients with biopsy proven glomerulonephritis as the cause of ESRD and followed for a median of 7.7 yrs was analyzed for incidence, risk factors and outcomes of recurrent disease post-transplant. At 5 yrs post-transplant, incidence of recurrence was 11.8% (MPGN), 5.1% (IgAN), 7.3% (FSGS) and 10% (Membranous). Younger age at transplant was an independent risk factor for recurrence of IgAN and FSGS. Glomerulonephritis recurrence was associated with an increased risk of overall and death-censored allograft loss. Recipients who developed recurrence were twice as likely to lose their allografts compared to those who did not experience recurrence. 5 yr graft survival for all glomerulonephritis types after disease recurrence was 55%. Patients with recurrent MPGN experienced the worst outcomes compared to other types of glomerulonephritis, with a 5 yr graft survival rate of 30% compared to 57% (FSGS), 58% (IgAN), and 59% (Membranous). Histologic details of the exact causes of graft loss were not available. Importantly, no independent effect of living kidney donation was observed. The use of maintenance corticosteroids was found to reduce the likelihood of reported recurrence of IgAN. This report had the typical limitations of a large registry study collecting longitudinal data over a 30 yr period.
  2. Cosio FG and Cattran DC. Recent advances in our understanding of recurrent primary glomerulonephritis after kidney transplantation. Kidney International; 91: 304-314, 2017.
    1. This review focuses on recent advances in our general understanding of the pathophysiology of primary glomerulonephritis, the risk of recurrence in the allograft, and the consequences for kidney graft survival. The authors focus particularly on FSGS, Membranous, MPGN and IgAN.
  3. Pippias M et al. Long-term kidney transplant outcomes in primary glomerulonephritis: Analysis from the ERA-EDTA Registry. Transplantation; 100: 1955-1962, 2016.
    1. Using data from 14,000 adult, first kidney transplants (1991-2010) from the ERA-EDTA Registry, the authors performed Kaplan-Meier, competing risk, and Cox regression analyses. The control group were patients with autosomal dominant polycystic kidney disease. Highlights include; worst adjusted graft survival for MPGN I and II, best 15 yr graft survival for IgAN patients, loss of living donor graft benefit for MPGN I and II,