Early Corticosteroid Withdrawal and Outcomes in IgAN after Transplantation

Immunoglobulin A nephrology (IgAN) is the most common biopsy-proven glomerular disease. Patients who develop IgAN following kidney transplantation commonly experience allograft loss. Previous studies have demonstrated an association between corticosteroid maintenance and a lower risk of recurrent glomerulonephritis, including IgAN. However, there are no differences in patient survival or death censored graft survival between use of steroids and no steroid use.

The Scripps Center for Organ and Cell Transplantation, La Jolla, California, utilizes a rapid corticosteroid withdrawal (CSW) protocol (d. 0-2 only) that is substantially lower than that at most transplant centers. Clinicians at the center, led by S. Kurian, conducted an analysis to compare clinical outcomes of transplant recipients with IgAN in the CSW program with results as reported in publicly available United Network for Organ Sharing (UNOS) data. Analysis results were presented during a poster session at the virtual American Transplant Congress 2020 in a poster titled IgA Nephropathy Outcomes after Kidney Transplantation in an Early Corticosteroid Withdrawal Center.

The analysis included all living and deceased donor renal transplant recipients at the center or from the UNOS transplant database from January 1, 1999, to December 31, 2018. Exclusion criteria were <18 years of age, liver-kidney transplantation, primary non-function, patients with retransplants, or loss to follow-up.

A total of 61 patients with IgAN native kidney disease from the Scripps Center were used for the analysis. Following application of the same exclusion criteria to the UNOS data and limiting of the UNOS cohort to patients on FK [tacrolimus] and mycophenolate mofetil maintenance, a total of 1991 patients with IgAN met the analysis criteria and were indicated as steroid free at discharge and no corticosteroid use indicated at any follow-up. The statistical comparisons of proportions utilized a 2-sample chi-squared test for equality of proportions with Yate’s continuity correction.

All-cause graft failures in patients with IgAN were not significantly different at the Scripps Center when compared with the UNOS Data (6.6% vs 5.1%, respectively; P<.80). In a comparison of all-cause mortality between the center and the UNOS data, there were no significant differences in IgAN mortality rates (8.2% vs 3.7%, respectively; P<.10).

In conclusion, the researchers said, “These preliminary findings indicate that patients at our center who are early corticosteroid withdrawal following transplant with IgAN as primary diagnosis have comparable outcomes in terms of all-cause graft failure and mortality with patients listed in UNOS. A limitation of the present study is that given the low incidence rates, we would require a larger cohort of patients to study at our center in order to make definitive statistical conclusions. However, these preliminary findings assure us that IgAN outcomes are not a cause of concern in our early corticosteroid withdrawal center.”

Source: Kurian S, Spierling S, Barrick B, Rice J, Case J, Marsh C. IgA nephropathy outcomes after kidney transplantation in an early corticosteroid withdrawal center. Abstract of a poster presented at the virtual American Transplant Congress 2020 (Abstract D-051), May 30, 2020.