Dr. Aditya Kadiyala (AK), Nephrology Fellow at Hofstra North Shore-LIJ School of Medicine, discusses his abstract for the National Kidney Foundation’s 2014 Spring Clinical Meetings (SCM14), Outcomes After Kidney Transplantation in Patients with IGA Nephropathy: An Analysis of the UNOS/OPTN Database, with Dr. Matt Sparks (eAJKD), eAJKD Advisory Board member. (Note: Dr. Kenar Jhaveri, eAJKD Editor, is one of the authors of this abstract.)
eAJKD: Why don’t you tell us a little about your research and abstract being presented at NKF 2014 Spring Meetings?
AK: I became interested in post kidney transplant outcomes in IgA nephropathy when a couple of my patients with IgA nephropathy and advanced CKD asked me about their options for renal replacement therapy. When I did a literature search, I was surprised to find out that there was no large US study evaluating the outcomes in patients with IgA nephropathy who undergo kidney transplantation. Our study uses the UNOS database to look at graft survival and patient survival in patients with ESRD receiving their first transplant, and compares those with and without IgA nephropathy. Our group looked at 5 years of time beginning at the day of kidney transplant. The cohort included patients who received their first kidney transplant between 1999 and 2008. The IgA nephropathy group had better unadjusted outcomes both for patient and death censored graft survival, compared to other patients who received kidney transplants who did not have IgA nephropathy. Similar trends were observed in the living donor and the deceased donor cohorts when analyzed separately. Our analysis also showed that the IgA nephropathy group were comparatively younger and had more males and Asians. There were fewer patients with diabetes in the IgA nephropathy group while hypertension and BMI were comparable in both the groups. It is also interesting to note that live donations occurred more frequently in the IgA nephropathy group.
eAJKD: Can you speculate whether the same trend towards improved graft survival in patients with IgA nephropathy would occur if recipient characteristics such as age, DM status were controlled for? How about comparing 1st time kidney transplant graft survival in IgA nephropathy to ADPKD?
AK: Multivariate analysis looking at outcomes after adjusting for various recipient characteristics like age, hypertension, gender, race, BMI, HLA mismatch, diabetes, PRA, duration of dialysis pre transplant and type of donor (living vs. deceased donor) is underway. It would be interesting to see what the results would be, as these factors can certainly impact the outcomes of both patient and graft survival. Patients with IgA nephropathy are relatively younger and are likely to have less incidence of diabetes. It is difficult to speculate whether improved graft survival would be seen after controlling for these factors, and we are in the process of conducting a pre-specified subgroup analysis of all patients with diabetes.
We have thought about comparing the outcomes with some other glomerulonephritides and ADPKD. However, to get a general idea of how patients with IgA nephropathy fare compared with any other person receiving a transplant, we decided to include all patients receiving a transplant during our pre-defined time period in our control group. Given that ADPKD doesn’t recur after transplant, it might not be fair to compare post transplant outcomes between IgA nephropathy and ADPKD. Recurrence of IgA nephropathy post transplantation can be as high as 35% and hence can affect the outcomes of graft survival, which is not the case with ADPKD.
eAJKD: Where do you and your group go from here?
AK: We plan at looking at various other glomerular diseases and assess their post transplant outcomes as we feel that there are many unanswered questions in this field. IgA nephropathy is a common glomerulonephritis, and our results hopefully will help nephrologists in every day clinical practice guide their patients with IgA nephropathy towards appropriate form of renal replacement therapy. From our unadjusted analysis of the UNOS database, kidney transplantation likely favors a better outcome for patients with IgA nephropathy compared to all other causes of kidney diseases.
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