IgA 신증 환자에서 신이식 후의 임상 경과 및 예후에 관한 연구

Abstract

Objectives : Primary IgA nephropathy is the most common type of glomerulonephritis, which may progress to end stage renal failure in about 30-35% of the cases. The incidence of recurrence of IgA nephropathy in transplanted kidney is approximately 50-60% but IgA nephropathy which is recurred in graft has relatively benign clinical course so the rate of graft loss due to recurrent IgA nephropathy is about 10%. Overall graft survival rate of IgA nephropathy is higher than other glomerular disorders which cause end stage renal disease according to recent clinical studies. However accurate causative disorders of end stage renal failure had seldom been reported by pathologic examination and accurate graft survival rate and recurrence rate of original disease after renal transplantation couldn't be investigated. We performed analysis of clinical outcome and prognosis for IgA group. Methods: 1259 cases of kidney transplantation were performed in the Severance hospital between Apr 1979 and Dec.1994. We selected 178 cases of those who got renal biopsy and excluded the cases of cadaveric transplants, hepatitis B antigen carrier, diabetes mellitus and not taking cyclosporine A. 178 cases of those were divided into two groups, IgA and nonIgA group. We performed analysis of 5 year graft and patient survival rate between two groups. The IgA group was divided into two group, recurrent and not-recurrent IgA group. We also performed analysis of recurrence rate and graft survival rate between two groups. Results: 1) 62 cases(35.2%) were IgA group and 116 cases were non-IgA group. 2) Male to female ratio of IgA group was 2.9:1, whose age averaged 35 years old. 3) Among 6 cases of the IgA group, 3 cases lost their graft due to chronic rejection, 2 cases due to recurrence and 1 case due to acute rejection. 4) The 5 year graft survival rate of IgA and nonIgA group were 85%, 90% each without statistical significance(p$gt;0.05). The 5 year patient survival rate of IgA and nonlgA group after renal allograft were 100%, 97% each without statistical significance(p$gt;0.05). 5) 266 cases of posttransplant kidney biopsies were performed and 10 cases were diagnosed as re- current IgA nephropathy with recurrence rate of 15%. 6) Renal insufficiency was noted in 4 cases of recurrent IgA nephropathy, 2 cases of those were chronic renal failure and the other 2 cases lost their graft. The histologic findings of these cases included mesangial widening and proliferation(4 cases), glomerulosclerosis(2 cases), crescent formation(1 cases). 7) The interval between transplantation and recurrence averaged 41 months. 24hr proteinuria and serum level of creatinine at the time of diagnosis averaged 2.6g and 2.2 mg/dl each. 8) Male to female ratio, age, HLA type and degree of HLA match showed no significant difference between nonrecurrent and recurrent IgA group in graft but 5 year graft survival rate of recurrent IgA group was lower than nonrecurrent group with statistical significance(71% vs 83%, p$lt;0.05). Conclusion: Recurrent IgA nephropathy in transplanted kidney might be one of major cause of graft loss with chronic rejection. However precise pathologic examination of before k after transplantation on larger patient population and more long term follow-up are advised.