Audit of posttransplant IgA nephropathy treatment strategies: single center study
Nadzeya Rapetskaya1, Kirill Komissarov2, Aleh Kalachyk2.
1Transplant nephrology, State institution Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Belarus; 2Nephrology, renal replacement trerapy and kidney transplantation, State institution Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Belarus
Introduction: IgA nephropathy (IgAN) is the prevalent form of recurrent disease which has negative influence on graft survival in kidney transplant recipients. Recurrence rate varies from 13% to 50% according to the data available. Approaches to the management of such patients are controversial and there are no any certain treatment recommendations for IgAN in kidney grafts to this day.
Methods: A retrospective single-center study, including 42 patients with biopsy-proven IgA nephropathy in kidney transplant, between January 2014 and August 2020, was performed. Treatment strategies were analyzed.
Results: Allograft IgAN manifestation time was from 1 to 122 month, with an average of 49,59 ± 30,34 month. The main clinical signs were proteinuria more than 1.0 g per 24 hours with and without hematuria – 45,24%; proteinuria less than 1.0 g per 24 hours with and without hematuria – 42,86%; isolated hematuria – 9,52%; elevation in serum creatinine – 2,38%.
18 (42,86%) patients were treated with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers and 11 (61,11%) of them have lost their grafts. 2 (4,76%) patients were managed with 8 mg of methylprednisolone. 22 (52,38%) recipients received pulse therapy consisted of 3 intravenous methylprednisolone infusions at a dose of 500 to 1000 mg followed by administration of methylprednisolone orally: 16 mg - 10 cases, 20 mg - 2 cases, 24 mg – 4 cases, 32 mg – 4 cases, 48 mg – 1 case. A dose reduction period varied from 3 to 12 month, maintenance dose was 4 mg. Renal allograft failure occurred in 11 (61,11%) patients on non-steroid regimen and 6 patients treated with steroids (p=0,18).
Conclusion: Lack of approved management concepts leads to various treatment regimens use in patients with posttransplant IgAN. Steroid application advisability as well as optimal dose and treatment duration remains debatable. Impact on graft survival rate is unclear. Multicenter randomized trials are required to develop kidney transplant IgA nephropathy patients care strategies.
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