Evaluation of kidney transplant outcomes in end-stage renal diseases associated with high risk of recurrence

Introduction: The prevalence of chronic kidney disease is progressively increasing worldwide. Among renal replacement therapies, kidney transplantation stands out compared to other renal replacement therapies for chronic kidney disease. Particularly, it offers advantages in patient comfort and mortality rates compared to other treatments. Recurrence is a concern in kidney transplant therapy for end-stage kidney disease secondary to glomerulonephritis. This becomes a significant issue, especially in diseases with a high potential for recurrence. Recurrence potential is notably high in focal segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), IgA nephropathy (IgAN), membranous glomerulonephritis (MGN), and atypical hemolytic uremic syndrome (aHUS) related end-stage kidney diseases. The recurrence and all the adverse factors that might result from it (graft loss, graft function loss, etc.) pose a crucial question in the literature regarding whether transplantation should be performed on these patients. Although there is a certain level of accumulated knowledge in the literature, there are still handicapped areas in determining whether transplantation should be performed on these patients or not. Graft loss due to recurrence rates has become a critical aspect in this regard. Our study aimed to evaluate the outcomes in patients undergoing kidney transplantation due to diseases with a high potential for recurrence. Materials and Methods: This study was designed as a retrospective analysis on 594 patients who underwent kidney transplantation at the Organ Transplantation Unit of the Akdeniz University Faculty of Medicine Hospital between April 2000 and December 2020. Among the 594 patients, 198 were evaluated in the group of diseases with a high potential for recurrence (FSGS, MPGN, MGN, IgAN, and aHUS). Demographic data of the included patients such as age, gender, BMI, kidney size, donor gender, HLA mismatch numbers, marginal donor numbers, panel reactive antigen numbers, etiology of chronic kidney disease, immunosuppressive therapy protocols, induction therapies, native nephrectomy, and viral hepatitis status were examined. Biopsy data taken before and after to confirm the diagnosis in diseases with a high potential for recurrence were utilized. Post-transplant, patients' proteinuria and creatinine levels were monitored at specific intervals. The values of creatinine, eGFR, albumin, LDL, hemoglobin, and proteinuria at 1 month, 6 months, 1 year, 3 years, 5 years, 10 years, and 20 years after kidney transplantation in high-risk patients were analyzed. Statistical analyses were performed using SPSS version 23.0. Results: Among the 198 patients in the high potential for recurrence disease group, recurrence was detected in 16 patients (8.1%). Recurrence rates were 13/73 (17.8%) in FSGS, 2/43 (4.7%) in MPGN, and 1/16 (6.3%) in MGN. During an average follow-up period of 65 (0-252) months, graft loss was observed in 21 cases of FSGS, 9 cases of MPGN, 8 cases of IgA nephropathy, 4 cases of MGN, and 2 cases of aHUS. There was no significant difference between the two groups in terms of graft loss (P=0.071).The graft survival rates were statistically significantly lower in patients with a high potential for recurrence (Log Rank=0.028). There were no significant differences observed in acute rejection rates, patient survival, delayed graft dysfunction, chronic allograft dysfunction, CMV, and BK virus. Although our study generally aligns with the literature, further studies involving a larger number of patients are needed.