Retransplant potential and repeat transplant outcome in patients with failed allografts attributed to recurrent glomerulonephritis
Ryan Gately1, Germaine Wong2,3, Armando Teixeira-Pinto3, Helen Pilmore4, William Mulley5, Wai Lim6,7,8.
1Princess Alexandra Hospital, Brisbane, Australia; 2Westmead Hospital, Sydney, Australia; 3University of Sydney, Sydney, Australia; 4Auckland City Hospital, Auckland, New Zealand; 5Monash Medical Centre, Sydney, Australia; 6Sir Charles Gairdner Hospital, Perth, Australia; 7University of Western Australia, Perth, Australia; 8Edith Cowan University, Perth, Australia
Introduction: Recurrent glomerulonephirits (GN) remains an important cause of late allograft loss after kidney transplantation, resulting in a high risk of mortality associated with a return to dialysis. Consequently, determining the relisting potential and allograft survival after repeat transplantation in these patients is essential, yet remains poorly understood.
Methods: Using data from ANZDATA, the associations between the causes of first kidney allograft loss, allograft loss following second kidney transplantation (2006-2021) and deceased donor transplant waitlisting (2016-2021) were examined using adjusted Cox regression analyses. Causes of first kidney allograft loss were categorized as: 1) GN-recurrence (first allograft loss from recurrent GN in patients with primary GN as cause of kidney failure), 2) GN-non recurrence (first allograft loss from causes other than recurrent GN in patients with primary GN), and 3) Non-GN (patients with non-GN causes of kidney failure).
Results: Of 3276 patients who received a second kidney transplant, 179 (5%) and 1449 (44%) lost their first allografts due to GN-recurrence and GN-non recurrence. Compared to the non-GN group, the respective adjusted HR (95%CI) for second kidney allograft loss of patients in the GN-recurrence and GN-non recurrence groups were 0.77 (0.59-1.00) and 1.02 (0.90-1.16). Of 81 patients with GN-recurrence who lost their second kidney allografts, 18 (22%) were attributed to recurrent GN. Between 2016-2021, 100 (63%), 688 (53%) and 736 (46%) patients in the GN-recurrence, GN-non recurrence and non-GN groups were enrolled on the deceased donor transplant waitlist, respectively. Compared to patients in the non-GN group, the adjusted HR (95%CI) of transplant relisting in the GN-recurrence and GN-non recurrence groups were 1.09 (0.88-1.34) and 1.16 (1.05-1.29), respectively.
Conclusion: Patients with prior kidney allograft loss from GN recurrence were not disadvantaged, with comparable relisting potential and outcomes following repeat transplantation to those without GN. However, more than 20% of these patients lost their second allografts from GN recurrence. A greater understanding of the biomolecular mechanisms of GN phenotypes at high risk of disease recurrence is critical in the decision-making process when considering retransplantation in those with prior allograft loss from GN recurrence.