Recurrence of glomerulonephritis (GN) in the allograft continues to be a significant cause of morbidity and graft loss in the renal transplant population, even with the improvement in short and long term kidney survival in the last 2 decades. It is estimated that between 5% to 10% of allografts fail due to recurrence of primary disease and their half life is diminished compared to those without recurrence.
Aim: The current study was to evaluate the impact of recurrent GN in renal transplant recipients (RTR) in our centre.
Materials and Methods: A retrospective analysis was done on 145 RTR with biopsy proven pre transplant diagnosis of GN for the prevalence and outcome of recurrent GN in the graft. The patients were followed up for an average of 5.1 years (61.2 months), with a minimum period of 1 year. Recurrent GN (Group1) was diagnosed by renal biopsy and the data from these patients were compared with those without recurrence (Group2).
Results: Recurrent GN (Group1) was diagnosed in 23 (15.8%) patients after an average period of 25.3 months and the diagnoses include Focal Segmental Glomerulosclerosis (FSGS), 13; IgA nephropathy (IgAN), 6; membranous nephropathy (MN), 2; membranoproliferative glomerulonephritis (MPGN), 1; and lupus nephritis (LN), 1. The results of group1 were compared with those of group 2 (n=122). The demographic characteristics of the two groups were not significantly different. The mean age was 48.1 years, males (n=13), females (n=10), the donor types were living related donor (LRD) n=9, living unrelated donor (LURD) n=14, deceased donor (DD) n=2, in group 1 compared to mean age 45.2 years, males (n=66), females (n=56), LRD (n=48), LURD (n=60), and DD (n=14) in group 2. The HLA mismatch was <3 (n=9) and >4 (n=14) and retransplants (n=2), in group 1 compared to HLA mismatch of <3 (n=54), >4 (n=68) in group 2. There were no patients with cold ischemia time (CIT) >20 hours in both the groups. The mean period of follow up for these patients was 5.1 years with a minimum period of 1 year and the mean period to diagnosis of recurrent GN was 25.3 months. Graft loss occurred in 5 (21.7%) patients in group 1 compared to 6 (4.9%) in group 2 and there were no patient loss in both the groups. Mean current serum creatinine was higher in group 1, 180 umol/L; compared to 123.8 umol/L in group 2. Recurrent GN is a significant problem after renal transplantation and is associated with increased incidence of graft loss and graft dysfunction.