대한신장학회

논문분류	춘계학술대회 초록집
제목	Allograft crescent predicts graft failure in recurrent IgA nephropathy patients.
저자	Sehoon PARK1, Hyunjeong CHO1, Mi-yeon YU3, Yong chul KIM3, Kyung chul MOON4, Yon su KIM1,2,3, *Hajeong LEE2,3
출판정보	2017; 2017(1):
키워드	Kidney transplantation, Crescent, Ig A nephropathy
초록	Objectives : A recent multicenter study demonstrates predictive value of crescents in native IgA nephropathy (IgAN), however, it remains unclear whether allograft crescent is associated with worse graft prognosis in kidney transplant recipients. Methods : We reviewed 376 IgAN patients who received kidney transplantation from 1979-2016 in a university hospital in Korea. Allograft biopsies were performed when patients had a significant proteinuria, hematuria, or a progressive deterioration of renal function. Clinical and pathologic characteristics at the time of biopsy were collected in recurrent IgAN cases. The degree of the crescent formation was classified into prominent (> 10%), mild (0-10%), and none (0%). The renal outcome was death-censored graft failure (DCGF). The association of the crescent formation and the renal prognosis was evaluated by multivariable Cox proportional hazard method. Results : During the follow-up duration of 7.0 (3.7-14.3) years, 122 (32.3%) patients were diagnosed as recurrent IgAN by allograft biopsy. Median time to recurrence was 4.1 (1.9-8.1) years. Recipients who recurred their IgAN were younger. They were donated allograft from younger donor and received less induction immunosuppressive treatment. Among the recurred IgAN patients, 36 (29.5%) reached graft failure after 9.3 (5.7-12.2) years from their transplantation. Moreover, IgAN recurrence itself was a strong time-dependent risk factor for DCGF (adjusted HR 2.703, 95% CI 1.608-4.545, P<0.001). Regarding the pathologic findings, crescent was identified in 20 patients with recurrent IgAN, in those with relatively old graft age, decreased renal function at the time of IgAN recurrence, and higher MEST scores. Interestingly, all five patients with prominent (>10%) crescent formation in their allograft biopsies progressed to consequent DCGF within from 0.4 to 4.6 years after the IgAN recurrence. Also, the presence of prominent (>10%) crescent in transplanted kidney was a strong risk factor for DCGF when compared with other recurrent IgAN patients without crescent formation (adjusted HR 6.313, 95% CI 1.699- 23.458, P=0.006), even after adjustment of MEST scores and coexisting rejection. Conclusions : Despite its rarity, a prominent allograft crescent (>10%) was demonstrated to attribute to rapid renal deterioration in recurrent IgAN patients. Treatment strategies for those patients should be investigated.
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