Background: Glomerulonephritis (GN) is a common cause of End Stage Renal Disease (ESRD), Kidney transplantation is the best treatment for patients with end stage renal disease. However, GN may recur post transplantation and lead to allograft failure. Several studies were done to estimate risk of recurrence and natural course of disease post transplantation in western population. However, no previous similar study was done in Saudi population. We aim to estimate the recurrence rate of GN post transplantation and it’s impact on kidney transplant survival.
Methods: Our study is a retrospective study of all adult kidney transplantation done at our center from January 2003 to end of December 2013. Patients with biopsy proven or clinically diagnosed nephrotic syndrome pre transplantation were included. Post-transplant recurrence was calculated as proportion based on biopsy and clinical outcome.
Results: 1397 adult patients underwent kidney transplantation, out of these 198 had GN as primary cause of kidney disease. 56.6% were males, 43.4 % females. 72 % were biopsy proven GN, remaining 28 % diagnosed based on history and clinical presentation. 88% were first transplant and 12 % were second transplant. From those who received first transplant 75 % were from living related donors, 4 % living non related and 21 % from deceased donor. Of those who had their second transplant 70 % were from living related donors, 10 % living non related and 20 % from deceased. Out of these kidney transplant recipients 12 (6%) had recurrent Gn. From these 6/12 was recurrent IgAN, 2/12 were FSGS, 1 /12 membranous, 3/12 SLE. Overall graft survival in patients with GN who received their first kidney transplant was 85% and for those with GN who received their second kidney transplant was 95%. Graft survival was 83.3 % in patients who had recurrent primary or secondary GN. The risk of recurrence in our study is much lower than international reported figures. We did not see difference in risk of recurrence between living vs. deceased donor transplantation nor degree of HLA matching.
Conclusion: Our study showed that 6% of kidney transplant recipients with GN as their cause of ESRD had recurrent GN post kidney transplantation. IgAN was the most type of GN that recurred most frequently followed by SLE. Recurrence of GN was lower in our population and did not affect graft survival.