Recurrent and De Novo Glomerulonephritis After Kidney Transplantation

Abstract

Glomerulonephritis is the primary disease in over a third of patients undergoing renal transplantation. All forms of glomerulonephritis may recur histologically in the renal allograft, but the incidence and severity of clinical recurrence vary greatly according to the type of glomerular disease. Recurrence may be early post-transplant or may take many years. Glomerular diseases that recur late will increase in clinical significance as advances in immunosuppression reduce rejection-mediated graft loss and prolong transplant survival. Registry data shows that the risk of graft loss from recurrence increases with the number of follow-up years, from 0.6% at the first postoperative year to 8.4% at 10 years. Recurrence was the third most frequent cause of allograft loss at 10 years, after chronic allograft failure and death with a functioning allograft. Interestingly, the use of more potent maintenance immunosuppressive agents or more potent induction agents such as alemtuzumab do not appear to reduce recurrence rates. De novo glomerulonephritis may also occur in renal transplants. This chapter reviews the incidence, clinical features, treatment, and impact on renal transplant survival of the major forms of de novo and recurrent glomerular disease.