Crescents in native kidney biopsies from patients with IgA nephropathy and the risk of recurrence after kidney transplantation: a retrospective cohort study, systematic literature review and meta-analysis of observational studies.
Gabriella Guzzo, Muaamar Al-Gobari, Cécile Jaques et al.
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In 30 seconds
This retrospective cohort study, systematic review and meta-analysis examined whether glomerular crescents in native kidney biopsies predict IgA nephropathy (IgAN) recurrence after kidney transplantation. The Lausanne cohort comprised 63 transplant recipients; the meta-analysis combined five additional cohorts, for 311 patients overall, 23% of whom had recurrent IgAN. Neither the Lausanne cohort nor the pooled analysis found an association between native-kidney crescents and recurrence. The pooled risk ratio was 1.53 (95% CI: 0.40-5.90), P = .41. The authors conclude that crescents may not predict allograft recurrence, despite their adverse prognostic significance for progression to kidney failure.
Key findings
- The Lausanne retrospective cohort included 63 kidney transplant recipients with IgAN and found no association between native-biopsy crescents and allograft recurrence.
- The meta-analysis combined 311 patients across six cohorts; 23% had recurrent IgAN.
- Pooled recurrence risk was not significantly associated with crescents: RR 1.53 (95% CI: 0.40-5.90), P = .41.
Why it matters
Crescents in native-kidney biopsies are an unfavorable prognostic feature for progression of IgAN to kidney failure, but that prognostic meaning may not extend to recurrence after transplantation. Distinguishing these outcomes can help avoid assuming that a marker of native-disease progression also predicts allograft recurrence. The pooled estimate is imprecise, so the evidence does not establish absence of an association.
What to keep in mind
The evidence comes from observational cohorts, and the pooled estimate is imprecise, with a wide 95% confidence interval.