List of Diseases Which Recur Following Renal Transplant

[Zach]

List of Diseases Which Recur Following Renal Transplant

Renal Fellow Network
Friday, December 19, 2008

Nearly any primary glomerulopathy has the possibility of recurring following a kidney transplant; however, the frequency and severity with which this occurs varies to a large degree.  For instance, evidence of mesangial IgA deposition can be seen in the majority of kidney transplant patients with a prior diagnosis of IgA Nephropathy; however, this does not typically lead to rapid allograft loss and therefore is not so clinically significant.  Recurrent primary FSGS, on the other hand, may occur commonly and with a severity that may indeed lead to graft loss.  The following is a partial list of some diseases with a high rate of recurrence following kidney transplant and their relative rates of frequency, taken in part from a short review in a 2007 Transplant Proceedings issue:

1.  Primary FSGS:  about 40% of cases will recur, many of which ultimately lead to allograft failure.  Plasma exchange and aggressive immunosuppression may be of value.

2.  Primary membranous nephropathy:  about 30% recurrence rate, though its severity is less than that of primary FSGS typically.  Also, de novo membranous nephropathy occurs in 1-2% of all transplants.

3.  MPGN:  type II MPGN has a recurrence rate of about 90%, whereas type I MPGN has a recurrence rate of only about 25%.

4.  HUS:  the D+ type of HUS typically does not recur post-transplant; however, the congenital forms of HUS (e.g. mutations in factor H, grouped amongst the D-type of HUS) recurs frequently.

5.  IgA Nephropathy/Henoch-Schonlein Purpura: recurs about 50% of the time but seldom causes allograft dysfunction.

6.  primary hyperoxaluria:  this disease occurs essentially 100% of the time unless it is performed as a dual liver-kidney transplant.

7.  diabetic nephropathy:  like IgA Nephropathy, pathologic hallmarks of diabetic nephropathy are commonly observed post-trasnsplant, but this damage typically takes years, if not decades, to become clinically significant.

There are probably others, but these are some of the major ones to remember.
Posted by nathanhellman at 2:58 PM

http://renalfellow.blogspot.com/2008/12/list-of-diseases-which-recur-following.html

[Chris]

Very interesting Zach

[petey]

For instance, evidence of mesangial IgA deposition can be seen in the majority of kidney transplant patients with a prior diagnosis of IgA Nephropathy; however, this does not typically lead to rapid allograft loss and therefore is not so clinically significant. 

5.  IgA Nephropathy/Henoch-Schonlein Purpura: recurs about 50% of the time but seldom causes allograft dysfunction.

As usual, my husband Marvin doesn't fit the statistics.  He had IgA Nephropathy, which destroyed both of his original kidneys.  A little less than three years after his transplant, IgA showed up in his transplanted kidney.  He kept the transplant for a total of three years, three months.   

[st789]

Good article Zach.  Very informative.

Oh, Marvin's IgA came back.  I am taking fish oil to prevent the it from coming back to my transplanted kidney.  Pray here.

Oh, being away for awhile, new desktop makes all work well.

[Zach]

Oh, being away for awhile, new desktop makes all work well.

Good to have you back, Scott!
 

[petey]

Oh, Marvin's IgA came back. I am taking fish oil to prevent the it from coming back to my transplanted kidney. Pray here.

He took fish oil, too -- for a little over three years and so much of it (dosage recommended by nephrologist) until Marvin said he thought he was growing gills.

[RichardMEL]

Question for the Z man...

is Primary FSGS the acute one or the chronic one, or neither?

I have FSGS but it's the chronic (or slower moving) version. I asked my neph about the chances of it re-occuring post transplant. His comment was that he thought it wasn't so likely, but even if it did it would more than likely act in the same way and be very slow acting on a transplanted kidney - reading between the lines he was suggesting a transplanted kidney could fail due to other causes rather than a reoccurance of my FSGS killing it off.

[Zach]

Question for the Z man...

is Primary FSGS the acute one or the chronic one, or neither?

I have FSGS but it's the chronic (or slower moving) version. I asked my neph about the chances of it re-occuring post transplant. His comment was that he thought it wasn't so likely, but even if it did it would more than likely act in the same way and be very slow acting on a transplanted kidney - reading between the lines he was suggesting a transplanted kidney could fail due to other causes rather than a reoccurance of my FSGS killing it off.

That's pretty much what mine said about my MPGN.