Background Patients who receive transplants following kidney failure due to glomerulonephritis (GN-KTx) constitute a significant portion of recipients and may face unique challenges post transplantation, related to the risk of GN recurrence and a higher global burden of immunosuppression.Methods We analyzed patient and graft outcomes, including the risk of graft loss in relation to recurrence in GN-KTx, compared to patients transplanted for other causes, using data from the prospective nationwide Swiss Transplant Cohort Study.Results Among 2631 included patients, 701 were GN-KTx, with IgA nephropathy being the most common GN subtype. GN-KTx recipients were younger and more likely to receive living donor organs. During a mean follow-up period of 5.3 years (IQR: 2.3-8.2), the 5-year cumulative incidence of graft loss was similar across groups, with GN-KTx at 6%. Notably, GN-KTx had a similar incidence of acute rejection as other groups. Recurrence occurred in 16% of GN-KTx within a mean time of 1.7 years (IQR: 0.28-2). Patients with recurrence faced a threefold higher risk of graft loss. Furthermore, disease recurrence was associated with a twofold higher risk of acute rejection compared to non-recurrent GN-KTx. Interestingly, regarding cancer risks, GN-KTx patients had the lowest incidence of skin cancer and no higher risk of non-skin cancers, despite greater exposure to immunosuppression compared to other KTx.Conclusions These real-life setting contemporary multicenter data highlight the importance of post-transplant monitoring for GN recurrence, given the strong association with poor graft outcomes and higher rejection rates. This is important in the context of current development of targeted therapies for glomerulonephritis in native kidneys that could be transposed to transplanted kidneys.
Halfon et al. (Wed,) studied this question.