Retransplant potential and repeat transplant outcome in patients with failed allografts attributed to recurrent glomerulonephritis.

Abstract

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. Method(s): 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). Result(s): 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(s): 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 decisionmaking process when considering retransplantation in those with prior allograft loss from GN recurrence.