IgAN & Kidney Transplants

The Foundation for IgA Nephropathy

IgAN & Kidney Transplants

Recurrence of IgAN. A common question about kidney transplants among IgAN patients is whether the IgAN will come back in the transplanted kidney. The answer is yes. Current information suggests that if all post-transplant IgAN patients were biopsied, IgAN would be found to have recurred in up to 50% of transplants within the first 10 years (and possibly 100% of them by 10-20 years, but that it leads to loss of the transplanted kidney in about 5 to 10% of patients (before graft loss occurs for other reasons). It is also thought that the rate of progression of any recurrence is unlikely to be faster than the original disease was. Based on that, transplant centers have no hesitation in transplanting IgAN patients. It's just not considered to be a factor. A kidney transplant is considered the best overall treatment for renal failure in IgAN patients after they reach end-stage renal disease. But there is really no way to predict how fast recurrence might happen in any given individual. Whatever it is about one's immune system that causes IgAN to happen in the kidneys, it doesn't go away simply because you got a kidney transplant. So, the possibility of recurrence in the new kidney remains, and it is somewhat unpredictable.

Likelyhood of recurrence greater with related live donor transplant? Another common question is whether a live kidney donation by a relative will increase the chances of recurrence. The answer is inconclusive, as most things are with IgAN, but it's possible that it increases the likelihood of recurrence. However, this is probably balanced out by the fact that live donor transplants usually last longer than cadaveric transplants. So again, transplant centers have no hesitation in performing related live donor transplants on IgAN patients.

It's a treatment. Transplant nephrologists would usually advise you not to worry about this. In all cases, a kidney transplant is a treatment, not a cure, no matter what kidney disease caused the renal failure. While every effort will be made to extend the transplant's life for as long as possible, a kidney transplant is never promised to last forever, and loss of the kidney due to rejection is a far greater concern than recurrence of IgAN. In a way, when you get to that stage, having gotten there due to IgAN is somewhat of a blessing, as opposed to, say, diabetes. IgAN patients are generally recognized as being among the very healthiest of kidney patients, other than having kidney failure. Therefore, the chances of qualifying for a kidney transplant are greater, and the chances of living a healthy life after the transplant are probably greater as well. Observations suggest that survival of a cadaveric kidney transplant in IgAN patients is among the highest among all ESRD patients from various causes, despite the risk of IgAN recurrence.

Not without risk. It's important to realize that a kidney transplant is not a panacea. It's simply a way to keep you off dialysis should you ever reach that point. There are risks associated with the surgery and with the subsequent immunosuppression. However, the vast majority of renal failure patients prefer a transplant rather than having to be on regular hemo or peritoneal dialysis. These are things which will be fully explained to you as part of your evaluation as a potential kidney transplant recipient.

It should be noted that IgAN is not the only primary nephropathy which recurs after transplant. This also happens with FSGS and MPGN Types I and II, for example.

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