Abstract

Background: Post-transplant immunoglobulin A (IgA) deposition can represent donor-related or de novo disease. We aimed to examine post-transplant outcomes in the setting of donor-related or de novo IgA deposition.

Methods: All renal biopsy records from 1/1/1995 to 31/12/2012 (n=7296) were reviewed. Cases with post-transplant IgA deposition were categorised as donor-related (6 months post-transplant) or recurrent. Donor-related and de novo cases had a clearly documented alternative cause of end-stage renal disease. The National Kidney Transplant Service (NKTS) database was accessed to facilitate a comparison of patient and graft outcomes in these cohorts and all other renal transplant recipients.

Results: Fifteen cases of post-transplant IgA deposition were deemed to be donor-related and had a mean MEST score of 1.4 (range 0-3). Serial biopsies in seven of these cases showed resolution of the deposits over time. Eight cases were deemed to represent de novo IgA deposition. The mean MEST score was 2.4 (range 0-4). There were no differences in patient and graft survival rates in these groups compared to all other transplants performed during a similar time period. Cox regression multivariate analysis did not identify either donor-related or de novo IgA deposition as a contributing factor to patient or graft survival.

Conclusions: Cases of donor-related or de novo IgA deposition were infrequently encountered in our review of ‘forcause’ biopsies. Neither condition, when histologically mild-moderate, was found to impact on patient or graft survival rates. This information is important for prognostication and counselling purposes in selected future cases.