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Previous Volume 347:103-109 July 11, 2002 Number 2 Next

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ABSTRACT

Background Recurrent glomerulonephritis is a known cause of renal allograft loss; however, the incidence of this complication is poorly defined. We determined the incidence, timing, and relative importance of allograft loss due to the recurrence of glomerulonephritis.

Methods A total of 1505 patients with biopsy-proved glomerulonephritis received a primary renal transplant in Australia from 1988 through 1997. Recurrence was confirmed by renal biopsy. The Kaplan–Meier method was used to estimate the 10-year incidence of allograft failure due to recurrent glomerulonephritis, and this incidence was compared with the incidence of acute rejection, chronic rejection, and death with a functioning allograft. Characteristics of the recipients and donors were examined as potential predictors of recurrence.

Results Allograft loss due to the recurrence of glomerulonephritis occurred in 52 recipients, with a 10-year incidence of 8.4 percent (95 percent confidence interval, 5.9 to 12.0). The type of glomerulonephritis, the sex of the recipient, and the peak level of panel-reactive antibodies were independent predictors of the risk of recurrence. Recurrence was the third most frequent cause of allograft loss at 10 years, after chronic rejection and death with a functioning allograft. Despite the effect of recurrence, the overall 10-year incidence of allograft loss was similar among transplant recipients with biopsy-proved glomerulonephritis and among those with other causes of renal failure (45.4 percent [95 percent confidence interval, 40.9 to 50.2] vs. 45.8 percent [95 percent confidence interval, 42.3 to 49.3], P=0.09).

Conclusions Recurrence is an important cause of allograft loss for those with renal failure due to glomerulonephritis. No risk factors for recurrence were identified that warrant altering the approach to transplantation. However, accurate estimates of risk can now be provided to potential recipients of renal allografts.

Source Information

From the Department of Epidemiology and Preventive Medicine, Monash University, Victoria (E.M.B., J.J.M.); the Renal Unit, Queen Elizabeth Hospital and Australia and New Zealand Dialysis and Transplant Registry, South Australia (G.R.R.); and the Department of Nephrology, Monash Medical Centre, Clayton, Victoria (R.C.A., S.J.C.) — all in Australia.

Address reprint requests to Dr. Chadban at the Department of Nephrology, Monash Medical Centre, 265 Clayton Rd., Clayton, Victoria, Australia, or at steven.chadban{at}med.monash.edu.au.

Full Text of this Article

Related Letters:

Recurrent Glomerulonephritis and Risk of Renal Allograft Loss
Cruzado J. M., Briganti E. M., Atkins R. C., Chadban S. J., the Australia and New Zealand Dialysis and Transplant Registry
Extract | Full Text | PDF  
N Engl J Med 2002; 347:1531-1532, Nov 7, 2002. Correspondence

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