TY - JOUR
T1 - The Dutch Transplantation in Vasculitis (DUTRAVAS) Study: Outcome of Renal Transplantation in Antineutrophil Cytoplasmic Antibody-associated Glomerulonephritis
AU - Goceroglu, Arda
AU - Rahmattulla, Chinar
AU - Berden, Annelies E.
AU - Reinders, Marlies E. J.
AU - Wolterbeek, Ron
AU - Steenbergen, Eric J.
AU - Hilbrands, Luuk B.
AU - Noorlander, Iris
AU - Berger, Stefan P.
AU - Peutz-Kootstra, Carine J.
AU - Christiaans, Martinus
AU - van Dijk, Marcory C. R. F.
AU - de Joode, Anoek A. E.
AU - Goldschmeding, Roel
AU - van Zuilen, Arjan D.
AU - Harper, Lorraine
AU - Little, Mark A.
AU - Hagen, E. Christiaan
AU - Bruijn, Jan A.
AU - Bajema, Ingeborg M.
PY - 2016/4
Y1 - 2016/4
N2 - BACKGROUND: Data on the outcome of renal transplantation in antineutrophil cytoplasmic antibody-associated glomerulonephritis (AAGN) patients are still limited. In particular, how disease recurrence in the renal allograft defines graft outcome is largely unknown. Therefore, we conducted a multicenter observational clinical and histopathological study to establish recurrence rate of AAGN in the allograft and the impact of recurrence on allograft survival. METHODS: Using the nationwide Dutch Pathology Registry (PALGA), we retrospectively collected clinical and histopathological data of consecutive AAGN patients who had developed end-stage renal failure and received a kidney allograft in 1 of 6 Dutch university hospitals between 1984 and 2011. Transplant biopsies were scored using the Banff '09 classification. Renal disease recurrence was scored using the histopathological classification of AAGN. RESULTS: The posttransplantation recurrence rate of AAGN was 2.8% per patient year, accumulating to recurrence in a total of 11 of 110 AAGN patients within the first 5 years after transplantation. Four of these 11 patients lost their graft, with 1-year and 5-year graft survival rates of 94.5% and 82.8%, respectively. By multivariate analysis, AAGN recurrence was independently associated with subsequent graft loss. CONCLUSIONS: In this study in 110 Dutch patients, the recurrence rate of AAGN within 5 years after kidney transplantation appeared slightly higher than in previous reports. Moreover, recurrence of AAGN contributed independently to kidney allograft loss, emphasizing the importance of clinical vigilance, because early treatment might be critical to rescuing the allograft.
AB - BACKGROUND: Data on the outcome of renal transplantation in antineutrophil cytoplasmic antibody-associated glomerulonephritis (AAGN) patients are still limited. In particular, how disease recurrence in the renal allograft defines graft outcome is largely unknown. Therefore, we conducted a multicenter observational clinical and histopathological study to establish recurrence rate of AAGN in the allograft and the impact of recurrence on allograft survival. METHODS: Using the nationwide Dutch Pathology Registry (PALGA), we retrospectively collected clinical and histopathological data of consecutive AAGN patients who had developed end-stage renal failure and received a kidney allograft in 1 of 6 Dutch university hospitals between 1984 and 2011. Transplant biopsies were scored using the Banff '09 classification. Renal disease recurrence was scored using the histopathological classification of AAGN. RESULTS: The posttransplantation recurrence rate of AAGN was 2.8% per patient year, accumulating to recurrence in a total of 11 of 110 AAGN patients within the first 5 years after transplantation. Four of these 11 patients lost their graft, with 1-year and 5-year graft survival rates of 94.5% and 82.8%, respectively. By multivariate analysis, AAGN recurrence was independently associated with subsequent graft loss. CONCLUSIONS: In this study in 110 Dutch patients, the recurrence rate of AAGN within 5 years after kidney transplantation appeared slightly higher than in previous reports. Moreover, recurrence of AAGN contributed independently to kidney allograft loss, emphasizing the importance of clinical vigilance, because early treatment might be critical to rescuing the allograft.
KW - ANCA-ASSOCIATED VASCULITIS
KW - SMALL-VESSEL VASCULITIS
KW - SYSTEMIC VASCULITIS
KW - WEGENERS-GRANULOMATOSIS
KW - ALLOGRAFT PATHOLOGY
KW - REMISSION-INDUCTION
KW - GRAFT-SURVIVAL
KW - UNITED-STATES
KW - RELAPSE RATE
KW - CLASSIFICATION
U2 - 10.1097/TP.0000000000000910
DO - 10.1097/TP.0000000000000910
M3 - Article
C2 - 26371598
SN - 0041-1337
VL - 100
SP - 916
EP - 924
JO - Transplantation
JF - Transplantation
IS - 4
ER -