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POST TRANSPLANT RECURRENT DISEASES

Q.778. Enumerate the causes of recurrent diseases post transplantation?

 

﴾﴾ VI. Recurrence  ﴿﴿

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.Renal transplantation- Allograft


Q.778. Enumerate the causes of recurrent diseases post transplantation?

A. Causes of recurrent diseases post transplantation:

1)   Idiopathic  FSGS 40%

2)   M.N. 40 %.

3)   M.P. type I.: 25 % & type II.: 80 %

4)   IgA  Np.: 25%

5)   TTP/HUS ClassicØ1 %, atypical20%, familial:80%.

6)   Anti-GBM A.B.: as high as 50%.

7)   PHx. (Oxalosis): (80-100) %.

8)   Diabetic Np.: (80-100) %.

9)   S .L.E.: (3-10) %.

10) Wegener’s dis.: < 20 %.

11)  Fabry dis.: < 5 %.

Q.779. How frequent is FSGS recurrence after T.x.? How to manage?

A. Incidence of recurrence of Iry FSGS reaches: 85 % (children) & 40 % (adults). Rapid recurrence occ. é👉Circulating G. permeability f.. Other causes incl.: [variety of viruses & drugs, incl.: Siros, podocin mutations (rare)]. Also described

Presentation: [Rapid onset of NRP ]. To detect early recurrence: screened for Prot é spot URAR é 1st postop. d., day of hospital discharge, then weekly /4 w., then monthly for one y. after Tx.. If ratio > 0.5 24-h. protein. R. biopsy performed if post-Tx. Prot >1 g./d. & histologic analysis should incl. E/M. Most immediate finding in recurrent FSGS  👉 foot process effacement, final Dgx. requires finding of FSGS on L.M., similar to Dgx in Iry FSGS.

Optimal ttt is not known, but the foll. is suggested: Rapid recurrence shd be ttt é Pph..typical reg.: 1.5 pl. vol. exchanges/3 consecutive d.s, then E.O.D./total 2 w.s. IV.IG (500 mg/kg) shd be given after Pph. to replace the I.G. removed by Pph..  Late recurrence: defined as later thn one y. after T.x. Csp (100 mg orally d.) as replacement for the antimetabolite such as Aza or MMF. If no resp. after 6-12 w., we attempt Pph., é same regimen described for rapid recurrence.  ACEI/ARBS should be initiated unless C.I. & Hyperlipidemia HMGCoA,  Homozyg. or heterozygous podocin mutations aggressive thpy (Poor response).

Q.780. What is the chance of membranous nephropathy to recur after transplantation? 

A. MN recurrence rate: 10-45 %. Mean time to recurrence, (typically as NRP) = 10 m. Affected ptns hv more aggressive initial dis. (progression to ESRD é 4 y.). The M-type phospholipase A2 receptor (PLA2R بلاتور , a transmembrane rec-eptor highly expressed in G. podocytes: def. as a mj. Ag in human idiop. MN. Pres. of auto-A.B. agnst this receptor,👉 underlying cause of recurrent MN.

Csp, tcrol. & MMf. don’t protect agnst dis. recurrence & there’s no evidence tht additional im/m. thpy alters the course. Rituximab successfully ttt recurrent disease partial or complete remission.. Post.ttt biopsies: “resorption of electron dense” immune deposits. (due to depletion of anti PLA2R autoA.B.). Living-related Tx. are at higher risk for recurrence , compared to deceased donorTx..

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Q.781. How frequent is TTP-HUS recurrent after transplantation? How to manage?

A. Recurrence rate of HUS after R.Tx. = 25-50 % (overestimate since both Ac. vasc. Rj. & CNI

👆 vascular injury &TMA indistinguishable fr. Iry disease). Multiple clinical ch. ch. may be ass. é recurrent HUS :

o   P.H. of non-Drr. causes (non-shiga associated  [NStx] HUS), much higher risk of recurrence thn those due to Drr.

o   Recurrence significantly ass. é :

1.    Older age” at onset of HUS.

2.    Short duration betw. dis. onset & ESRD or Tx.,

3.    Living related donors & to a lesser degree, CNI.

4.    Familial HUS, due to mutations é complement inhibitor genes .

5.    Limited evidence: lower recurrence rate é “nephrectomy”.

Affected ptn.s typically present with a “microangiopathic hemolytic anemia”, thrombocytopenia & ARF. Graft loss reported in 10-50 % of cases.

Prognosis: Overall graft success may be diminished. Recurrence is invariable é familial dis.. Managementtwo phases: 1st phase Prevention by: [Low-dose aspirin + dipyridamole]. [Csp & ALS] shd be used cautiously.

2nd phase: ttt of recurrent HUS. Csp dose shd be reduced by 50% é 1st Sn of recurrence. Pl. infusions & pl. exchange, similar to tht used for Iry disease

Q.782. How frequent is IgA nephropathy recurrence after transplantation?

A. Donor  source hs a role in timing of recurrence ('Donor effect'). So, the adv. in allograft survival é living-related comp. to deceased donor may be negated.

Ptn.s é rapidly progressive course of native IgAN should be informed tht recurrence may present early, wch. should not preclude consideration for subsequent re-T.x.

ACEI or ARBs should be initiated é evidence of recurrence. Whether routine, early post-Tx. initiation of these drugs to all recipients é native IgAN, independent of recurence, is beneficial is unknown. At least, they should be incl. as first line anti-H.T. Benefit of fish oil, remain to be tested. There’s no evidence that any im/m., alone or in combination, is beneficial in preventing recurrence or altering the course of recurrence.

Q.783. How likely is anti-GBM antibody disease to recur after transplantation?

A. Incidence of recurrence: as high as 50 %. However, most ptn.s aSm.c. The relatively low rate of significant recurrence is thought to be due to delaying R.Tx. until Circulating anti-GBM A.B. hv bn undetectable for at least 12 m. & there hs bn 6 m. at least post-ttt quiescent dis (without cytotoxic Ag.). Lack of late recur-ence reflects the self-limited nature of autoA.B. formation in this dis.. In addition, maintenance im/m. therapy may help suppress autoA.B. production.

Clinically evident recurrence typically present é[hematuria & proteinuria].“Spontaneous resolution” can occur Graft loss due to recurrent anti-GBM A.B. dis. is rare. ttt.:[Pulse steroids, Cph. & pl. exchange] , esp é life-threatening pulm. disease.

Q.784. How likely is Membranoproliferative G.N. to recur after transplantation?

A. Recurrent MPGN is not uncommon event, esp. é type II disease.While expected graft survival is dcr. é setting of recurrent MPGN, many grafts will continue to hv adequate function & eventually lost for reasons other than recurrence.

Given the lack of a proven beneficial therapeutic intervention, aggressiveness of ttt. should match the aggressiveness of disease process. Presence of hepatitis C & CMV should be evaluated & ttted accordingly. No data suggest: T.x. é deceased donor rather a living donor hs favorable effect on graft survival by decrease likelihood of recurrence.

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POST TRANSPLANT RECURRENT DISEASES
Q.778. Enumerate the causes of recurrent diseases post transplantation?
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
fedo
https://www.fedokidney.com/2020/10/post-transplant-recurrent-diseases.html
https://www.fedokidney.com/
https://www.fedokidney.com/
https://www.fedokidney.com/2020/10/post-transplant-recurrent-diseases.html
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