Crescents on the native biopsy did not significantly predict IgA recurrence in the transplanted kidney

Design

Single-centre retrospective cohort plus systematic review and meta-analysis of observational studies

Population

311 kidney transplant recipients with IgA nephropathy from six cohorts

Primary outcome

IgA nephropathy recurrence in the allograft

Effect

RR 1.53 (95% CI 0.40 to 5.90), P = 0.41

Researchers studied 63 transplant recipients with IgA nephropathy in Lausanne and pooled them with five other cohorts.

Crescents on the original native biopsy were not significantly associated with recurrence in the graft. Heterogeneity in how crescents were reported limits the analysis.

The result means crescents should not drive transplant counselling on their own, though the data are too sparse to call them irrelevant.

• About 23% of 311 recipients had IgA recurrence.
• Crescents were present in 12 to 62% of native biopsies across cohorts.
• The pooled risk ratio was 1.53 with an interval from 0.40 to 5.90.
• Crescents above 25% of glomeruli remain a marker of faster native progression.

Why it matters

Crescents predict progression in native IgA nephropathy, and it is tempting to assume they also predict recurrence in the graft.

Don't overread it

The interval is very wide; a meaningful association has not been excluded.

The statistics, in plain English

A risk ratio of 1.53 with an interval from 0.40 to 5.90 is compatible with anything from a strong protective effect to a large increase in risk. This is absence of evidence, not evidence of absence.

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