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List of Diseases Which Recur Following Renal Transplant

Posted Dec 19 2008 12:00am
Nearly any primary glomerulopathy has the possibility of recurring following a kidney transplant; however, the frequency and severity with which this occurs varies to a large degree.  For instance, evidence of mesangial IgA deposition can be seen in the majority of kidney transplant patients with a prior diagnosis of IgA Nephropathy; however, this does not typically lead to rapid allograft loss and therefore is not so clinically significant.  Recurrent primary FSGS, on the other hand, may occur commonly and with a severity that may indeed lead to graft loss.  The following is a partial list of some diseases with a high rate of recurrence following kidney transplant and their relative rates of frequency, taken in part from a short review in a 2007 Transplant Proceedings issue:

1.  Primary FSGS:  about 40% of cases will recur, many of which ultimately lead to allograft failure.  Plasma exchange and aggressive immunosuppression may be of value.

2.  Primary membranous nephropathy:  about 30% recurrence rate, though its severity is less than that of primary FSGS typically.  Also, de novo membranous nephropathy occurs in 1-2% of all transplants.

3.  MPGN:  type II MPGN has a recurrence rate of about 90%, whereas type I MPGN has a recurrence rate of only about 25%.

4.  HUS:  the D+ type of HUS typically does not recur post-transplant; however, the congenital forms of HUS (e.g. mutations in factor H, grouped amongst the D-type of HUS) recurs frequently.

5.  IgA Nephropathy/Henoch-Schonlein Purpura: recurs about 50% of the time but seldom causes allograft dysfunction.

6.  primary hyperoxaluria:  this disease occurs essentially 100% of the time unless it is performed as a dual liver-kidney transplant.

7.  diabetic nephropathy:  like IgA Nephropathy, pathologic hallmarks of diabetic nephropathy are commonly observed post-trasnsplant, but this damage typically takes years, if not decades, to become clinically significant.

There are probably others, but these are some of the major ones to remember.
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