The risk of a posttransplant recurrence of secondary
glomerulonephritis (GN) is quite variable. Histologic recurrence is frequent in
lupus nephritis, but the lesions are rarely severe and usually do not impair the long-term graft outcome. Patients with Henoch-Schonlein
nephritis have graft survival similar to that of other renal diseases, although recurrent Henoch-Schonlein
nephritis with extensive crescents has a poor prognosis.
Amyloid light-chain
amyloidosis recurs frequently in renal allografts but it rarely causes graft failure.
Amyloidosis secondary to chronic
inflammation may also recur, but this is extremely rare in patients with
Behcet's disease or in those with
familial Mediterranean fever, when the latter are treated with
colchicine. Double
organ transplantation (liver/kidney; heart/kidney),
chemotherapy, and autologous
stem cell transplantation may be considered in particular cases of
amyloidosis, such as
hereditary amyloidosis or
multiple myeloma. There is little experience with
renal transplantation in light-chain deposition disease, fibrillary/immunotactoid GN, or mixed cryoglobulinemic
nephritis but successful cases have been reported.
Diabetic nephropathy often recurs but usually only after many years. Recurrence in patients with small vessel
vasculitis is unpredictable but can cause graft failure. However, in spite of recurrence, patient and graft survival rates are similar in patients with small vessel
vasculitis compared with those with other renal diseases. Many secondary forms of GN no longer represent a potential
contraindication to
renal transplantation. The main issues in
transplantation of patients with secondary GN are the infectious, cardiovascular, or hepatic complications associated with the original disease or its treatment.