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NDT Advance Access published online on March 29, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh773
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received July 25, 2004
Accepted February 11, 2005

Original Articles

Recurrent IgA nephropathy after renal transplantation despite immunosuppressive regimens with mycophenolate mofetil

Arun Chandrakantan 1*, Piti Ratanapanichkich 2, Mowaffaq Said 2, Catherine V. Barker 2, and Bruce A. Julian 1

1 Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
2 Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

* To whom correspondence should be addressed.
Arun Chandrakantan, E-mail: arunc{at}uab.edu



  Abstract

Background. Transplantation offers an excellent option for patients with immunoglobulin-A nephropathy (IgAN) with severe renal dysfunction. However, IgAN frequently recurs in allografts treated with azathioprine. We examined the impact of mycophenolate mofetil immunosuppression on recurrence of IgAN.

Methods. We reviewed the charts of patients transplanted for IgAN at our institution in the cyclosporin era. Patients were excluded from further analysis if follow-up was <12 months or if immunosuppression at engraftment did not include azathioprine or mycophenolate mofetil. Laboratory data, medications and allograft biopsy findings were compiled.

Results. 152 kidney transplantations met the study criteria. At engraftment, 61 allografts were treated with azathioprine and 91 with mycophenolate mofetil. By 3 years post-transplant, IgAN developed in six of 60 (10.0%) azathioprine-treated allografts and five of 62 (8.1%) mycophenolate mofetil-treated allografts (P = 0.76). Overall, 13 azathioprine-treated and seven mycophenolate mofetil-treated allografts showed recurrence. As expected in this retrospective study, the duration of observation was longer in the azathioprine group. The interval between engraftment and diagnosis of recurrent disease was also longer. Survival of allografts with recurrent IgAN was similar in the two groups. Survival of allografts with recurrent IgAN was worse than for allografts without recurrence or allografts transplanted into patients with non-IgAN renal failure. Neither switching azathioprine to mycophenolate mofetil nor using an angiotensin-converting enzyme inhibitor or angiotensin-II type 1 receptor blocker ameliorated the clinical course after a biopsy documented recurrent IgAN.

Conclusions. Mycophenolate mofetil, compared with azathioprine, did not lessen the recurrence of IgAN or its clinical impact.

Keywords: IgA nephropathy; mycophenolate mofetil; recurrent IgA nephropathy; renal transplantation.
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