Figure 1724

Up to 75% of patients with immunoglobulin A (IgA) disease develop histologic recurrence within their grafts, which usually presents with microscopic hematuria and proteinuria [4,14,15]. Many patients, however, only will have recurrence noted on a routine biopsy after transplantation. Most studies suggest that the risk of graft loss resulting from recurrent disease is low (<10%) [4]. However, long-term follow-up in some studies has suggested an increasing rate of graft loss with time, approaching 20% at 46 months [14,15]. Conversely, one study has documented 100% graft survival at 2 years in patients with IgA disease who had IgA anti-human leukocyte antigen (HLA) antibodies [34]. The mechanism is unclear. The association of IgA disease and the HLA alleles B35 and DR4 may explain the increased risk of recurrence in grafts from living related donors because family members are more likely to share HLA genes.

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