Efficacy of galactose-deficient IgA1 as a biomarker for predicting IgA nephropathy recurrence after kidney transplantation: a retrospective case-control study

doi:10.21203/rs.3.rs-4872461/v1

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Efficacy of galactose-deficient IgA1 as a biomarker for predicting IgA nephropathy recurrence after kidney transplantation: a retrospective case-control study

https://doi.org/10.21203/rs.3.rs-4872461/v1

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Background

Allogeneic kidney transplantation (KT) is an effective treatment for end-stage renal disease caused by progressing immunoglobulin A nephropathy (IgAN). However, the post-KT IgAN recurrence rate is high and can shorten long-term graft survival. Therefore, early prediction of IgAN recurrence risk is crucial for improving transplantation outcomes. We hypothesized that serum galactose-deficient IgA1 (Gd-IgA1), APRIL, B-cell activating factor (BAFF), and sCD89 levels could help predict IgAN recurrence post-KT. Thus, this study aimed to validate our hypothesis in Chinese patients with IgAN.

Methods

In this retrospective case-control study, we examined patients with primary IgAN who underwent KT at the First Affiliated Hospital, Sun Yat-sen University from September 2014 to December 2019. Patients were divided into post-transplantation IgAN recurrence (n = 12) and non-recurrence (n = 13) groups. Serum levels of Gd-IgA1, APRIL, BAFF, and sCD89 were measured at pre-transplantation and at 1–6, 6–12, 12–24, and > 24 months post-transplantation.

Results

The area under the curve for predicting IgAN recurrence at 1–6 months post-transplantation was 0.91 (95% confidence interval [CI], 0.78–1; cutoff, 4.2 µg/mL), 0.79 (95% CI, 0.58–1; cutoff, 933 pg/mL), and 0.8 (95% CI, 0.6–1; cutoff, 1791 pg/mL) for Gd-IgA1, BAFF, and APRIL, respectively. At 6–12 months post-transplantation, it was 0.82 (95% CI, 0.6–1; cutoff, 2.37 µg/mL) and 0.9 (95% CI, 0.74–1; cutoff, 992 pg/mL) for Gd-IgA1 and BAFF, respectively. Finally, at 12–24 months post-transplantation, it was 0.91 (95% CI, 0.76–1; cutoff, 3.83 µg/mL) for Gd-IgA1. Compared to patients with post-transplantation Gd-IgA1 levels < 4.2 µg/mL, patients with Gd-IgA1 levels ≥ 4.2 µg/mL at 1–6 months post-transplantation had a hazard ratio (HR) of 25.38 (95% CI, 2.5–257.88, p = 0.006) for IgAN recurrence. BAFF levels at 1–6 months post-transplantation were protective against IgAN recurrence (HR, 0.03; 95% CI, 0–0.48; p = 0.013).

Conclusions

Serum Gd-IgA1 levels could effectively predict IgAN recurrence risk in patients post-KT.

B-cell activating factor

galactose-deficient IgA1

immunoglobulin A nephropathy recurrence

kidney transplantation

Immunoglobulin A nephropathy (IgAN) is the most prevalent primary glomerulonephritis worldwide, with an estimated annual incidence of 2.5/100,000 (1). The prevalence of IgAN varies geographically, with lower rates in North America and Europe and higher rates in East Asian countries, where it is the leading cause of kidney failure. In China, IgAN accounts for 58.2% of the confirmed glomerulonephritis cases (2), with approximately 30–40% of the patients progressing to end-stage kidney disease and requiring renal replacement therapy (3, 4). However, IgAN recurrence post-kidney transplantation (KT) has been reported in 35–60% of the cases, with 7–10% resulting in graft loss (5, 6). Furthermore, IgAN recurrence can shorten long-term graft survival (7). Therefore, early prediction of IgAN recurrence risk is key for improving transplantation outcomes.

Although the pathogenesis of IgAN is not fully understood, current evidence increasingly supports Suzuki's 'four-hit' theory, stating that patients with IgAN have significantly higher levels of galactose-deficient IgA1 (Gd-IgA1) and circulating immune complexes in their blood when compared with control patients (8–11). The pathogenesis of IgAN also applies to post-transplantation IgAN recurrence (12). Previous studies have shown that Gd-IgA1, proliferation-inducing ligand (APRIL), B-cell activating factor (BAFF), and CD89 are involved in the pathogenesis of IgAN (13). However, previous studies have not elucidated the dynamic changes in IgAN biomarkers in patients with KT from pre-transplant to post-transplant, nor have they identified the critical time period during which the differences in IgAN biomarker levels are most pronounced between patients with and without recurrence.

In this study, we aimed to investigate differences in serum levels of Gd-IgA1, APRIL, BAFF, and sCD89 at different time periods between patients with post-transplantation IgAN recurrence and non-recurrence and identify biomarkers that could predict IgAN recurrence early after kidney transplantation.

Study population

This retrospective case-control study included patients who underwent kidney transplantation at the Organ Transplantation Department of the First Affiliated Hospital of Sun Yat-sen University between September 2014 and December 2019. The inclusion criteria were (i) IgAN as the biopsy-confirmed primary disease, (ii) age > 16 years, and (iii) post-transplantation follow-up duration longer than 4 years. The exclusion criteria were (i) secondary transplantation and (ii) multi-organ transplantation.

Finally, 25 patients of Han Chinese descent who met the inclusion criteria were included in this study. Based on IgAN recurrence after kidney transplantation, patients were divided into the IgAN recurrence group (12 patients) and the IgAN non-recurrence group (13 patients). Their previous stored serum samples from five separate time periods were examined for four markers: Gd-IgA1, BAFF, APRIL, and sCD89. The five time periods were as follows: pre-transplantation and post-transplantation at 1–6, 6–12, 12–24, and > 24 months. This study was approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University (Approval No. : [2023]169) and conducted in accordance with the principles of the Helsinki Declaration.

Immunosuppressive regimen

The immunosuppressive induction regimen included either rabbit anti-human thymocyte immunoglobulin (n = 20) or basiliximab (n = 5) combined with methylprednisolone. All patients received 500 mg of intravenous methylprednisolone three times during the surgery and for the first 2 days post-surgery. The maintenance immunosuppressive regimen included glucocorticoids, calcineurin inhibitors, and anti-proliferative agents. Oral prednisone tablets were begun at 30 mg/day (or methylprednisolone tablets at 20 mg/day) on day 3 post-surgery, with a weekly reduction of 5 mg (or methylprednisolone tablets of 4 mg) until reaching a maintenance dose of 5–10 mg/day (or methylprednisolone tablets of 4–8 mg/day).

IgAN diagnosis

The indications for renal biopsy are elevated serum creatinine, proteinuria, and/or haematuria. After local anaesthesia, a renal transplant biopsy was performed using a 16-G automatic biopsy needle (Bard Company, Murray Hill, NJ, USA) under ultrasound guidance to collect two samples of renal transplant tissue for evaluation. The biopsy tissue was subjected to routine pathological staining and fluorescence immunohistochemistry, which included IgA, IgG, IgM, C3, Clq, Fg, and C4d. The pathological diagnosis of IgAN is based on the finding of granular IgA deposits in the glomerular mesangial region, as identified using immunohistochemistry (14).

Laboratory tests

The levels of four biomarkers, including Gd-IgA1 (KM55 ELISA assay, #27600, Immuno-Biological Laboratories), APRIL (APRIL/TNFSF13 Luminex®, #LXSAHM-01, R&D System), BAFF (Human Luminex® Discovery Assay (BAFF/BLyS/TNFSF13B), #LXSAHM-01, R&D System), and sCD89 (Human FCAR / CD89 ELISA Kit, #LS-F35810-1, Lifespan), were measured using the corresponding commercial assay kits according to the manufacturer instructions.

Statistical analysis

We used the Gtsummary package to create descriptive statistics for baseline characteristics. Continuous variables are expressed as medians and interquartile ranges (IQRs), and the Wilcoxon rank-sum test was used for between-group comparisons. Categorical variables are presented as counts and percentages, and between-group comparisons were performed using the chi-square or Fisher's exact tests. We used boxplots to display differences in various measured indicators between the recurrence and non-recurrence groups at different time periods. Differences between groups were evaluated using the Wilcoxon rank-sum test. A receiver operating characteristic (ROC) curve analysis was performed to determine the predictive ability of Gd-IgA1, BAFF, and APRIL levels at 1–6 months, 6–12 months, and 12–24 months post-transplantation for patient recurrence. Statistical analyses were performed using R 4.3.1 software, with p-values < 0.05 being considered as statistically significant.

Patient characteristics

This study included 25 patients with IgAN: 12 patients with IgAN recurrence and 13 patients without IgAN recurrence post-kidney transplantation. The baseline characteristics and clinical information for both groups are summarized in Table 1. The median time to recurrence in the recurrence group was 2.19 years (IQR, 0.97–3.49), with a median follow-up time of 5.47 years (IQR, 4.66–6.58). The median follow-up time for the non-recurrence group was 5.52 years (IQR, 5.21–5.93). Donor type was significantly associated with recurrence (P = 0.04), with living donors having relative higher risk.

Table 1

Basic and clinical characteristics of the study population
Characteristic	Non-Recurrent, N = 13	Recurrent, N = 12	p-value¹
Age (years), median (IQR)	38 (33, 43)	31 (27, 38)	0.11
Sex, female, n (%)	8 (62%)	6 (50%)	0.60
Time on dialysis (months), median (IQR)	10 (6, 26)	7 (3, 30)	0.94
Dialysis modalities, n (%)			0.60
haemodialysis	7 (54%)	7 (58%)
peritoneal dialysis	4 (31%)	5 (42%)
No dialysis	2 (15%)	0 (0%)
Type of donor, n (%)			0.04
Deceased donor	13 (100%)	8 (67%)
Living donor	0 (0%)	4 (33%)
Donor age(years), median (IQR)	27 (15, 36)	45 (24, 53)	0.20
Donor sex, female, n (%)	3 (23%)	2 (17%)	1.00
Cold ischaemia time (hours), median (IQR)	10.0 (6.4, 14.0)	7.8 (5.3, 10.9)	0.40
PRA positive, n (%)	3 (23%)	3 (25%)	1.00
AB0 matching, n (%)	13 (100%)	12 (100%)	1.00
Induction therapy, n (%)			0.60
ATG	11 (85%)	9 (75%)
Basiliximab	2 (15%)	3 (25%)
Immunosuppressive regimen, n (%)			0.70
CsA/EC-MPS/steroid	0 (0%)	1 (8.3%)
Tac/EC-MPS/steroid	11 (85%)	8 (67%)
Tac/MMF/steroid	1 (7.7%)	1 (8.3%)
Tac/MZR/steroid	1 (7.7%)	2 (17%)
Allograft rejection, n (%)	1 (7.7%)	0 (0%)	1.00
24-h proteinuria positive, n (%)
at 6 months	1 (7.7%)	3 (25%)	0.30
at 1 year	1 (7.7%)	4 (33%)	0.20
at 2 years	2 (15%)	5 (42%)	0.20
at 3 years	2 (15%)	7 (58%)	0.04
Serum creatinine, median (IQR), (µmol/L)
at 6 months	92 (80, 136)	119 (89, 141)	0.30
at 1 year	87 (78, 131)	110 (97, 133)	0.13
at 2 years	86 (81, 125)	120 (102, 141)	0.08
at 3 years	91 (80, 130)	116 (89, 139)	0.30
Time to recurrence(years), median (IQR)		2.19 (0.97, 3.49)
Duration of follow-up (years), median (IQR)	5.52 (5.21, 5.93)	5.47 (4.66, 6.58)	0.90
Serum creatinine at the last follow-up, median (IQR)	103 (83, 129)	137 (126, 160)	0.02
1. Pearson’s Chi-squared test; Fisher’s exact test; Wilcoxon rank-sum exact test; Wilcoxon rank-sum test
N, number; IQR, interquartile range; HLA, human leukocyte antigen; PRA, panel reactive antibody; CsA, ciclosporin; ATG, antithymocyte globulin; EC-MPS, enteric-coated mycophenolate sodium; IQR, interquartile range; Tac, tacrolimus; MMF, mycophenolate mofetil; MZR, mizoribine

Compared to the non-recurrence group, the recurrence group had a high proportion of patients with positive 24-hour proteinuria three years after transplantation (p = 0.04). As of the last follow-up, the recurrence group had notably higher serum creatinine levels than the non-recurrence group (137 µmol/L vs. 103 µmol/L, p = 0.02).

Biomarker differences in patients with and without IgAN recurrence after KT

We examined the variances in serum levels of Gd-IgA1, BAFF, APRIL, and sCD89 between the IgAN recurrence and non-recurrence groups at different time periods post-KT. Gd-IgA1 levels were significantly higher in the recurrence group at 1–6 months, 6–12 months, and 12–24 months post-transplantation than in the non-recurrence group (5.30 µg/mL vs. 1.78 µg/mL, p = 0.001; 4.20 µg/mL vs. 2.03 µg/mL, p = 0.042; 4.65 µg/mL vs. 2.16 µg/mL, p = 0.005, respectively) (Fig. 1A). Gd-IgA1 levels were high in multiple time periods in four recurrence patients and low in four non-recurrence patients (Fig. 2A). At 1–6 months and 6–12 months post-transplantation, BAFF levels were significantly lower in the recurrence group than in the non-recurrence group (878 pg/mL vs. 1153 pg/mL, p = 0.028; 923 pg/mL vs. 1303 pg/mL, p = 0.008, respectively) (Fig. 1B). Compared to levels before transplantation, BAFF levels in the 1–6 months post-transplantation decreased significantly more in the recurrence group than in the non-recurrence group (Fig. 2B).

No significant differences were observed in sCD89 levels between groups in any time period (Fig. 1C). Compared to those before transplantation, the levels of sCD89 levels decreased after transplantation (Fig. 2C). At 1–6 months post-transplantation, APRIL levels were significantly higher in the recurrence group than in the non-recurrence group (1795 pg/mL vs 1386 pg/mL, p = 0.025) (Fig. 1D). Following transplantation, APRIL levels were higher than those pre-transplantation (Fig. 2D).

Predictive value of biomarkers for IgAN recurrence after KT

Subsequently, ROC curves were utilised to assess the predictive capability of Gd-IgA1, BAFF, and APRIL levels at 1–6 months, 6–12 months, and 12–24 months post-KT for IgAN recurrence, as shown in Table 2 and Fig. 3. The area under the curve (AUC) for predicting IgAN recurrence at 1–6 months post-transplantation was 0.91 for Gd-IgA1 (95% CI, 0.78–1; cutoff, 4.2 µg/mL), 0.79 for BAFF (95% CI, 0.58–1; cutoff, 933 pg/mL) and 0.80 for APRIL (95% CI, 0.6–1; cutoff, 1791 pg/mL). The AUC for predicting IgAN recurrence at 6–12 months post-transplantation was 0.82 for Gd-IgA1 (95% CI, 0.6–1; cutoff, 2.37 µg/mL) and 0.90 for BAFF (95% CI, 0.74–1; cutoff, 992 pg/mL). The AUC for Gd-IgA1 levels at 12–24 months after transplantation was 0.91 (95% CI, 0.76–1; cutoff, 3.83 µg/mL).

Table 2

Performance of Gd-IgA1, BAFF, and APRIL to predict IgA recurrence at different time periods after transplantation
Time	Marker	AUC	95% CI	Cutoff	Specificity	Sensitivity
1–6 months	Gd-IgA1 (µg/mL)	0.91	0.78–1	4.2	1.00	0.67
	BAFF (pg/mL)	0.79	0.58–1	933	0.92	0.67
	APRIL (pg/mL)	0.80	0.6–1	1791	0.83	0.75
6–12 months	Gd-IgA1 (µg/mL)	0.82	0.6–1	2.37	0.60	1.00
	BAFF (pg/mL)	0.90	0.74–1	992	0.90	0.83
	APRIL (pg/mL)	0.55	0.12–0.98	1695	0.80	0.50
12–24 months	Gd-IgA1 (µg/mL)	0.91	0.76–1	3.83	0.91	0.83
	BAFF (pg/mL)	0.76	0.48–1	983	0.73	0.83
	APRIL (pg/mL)	0.64	0.35–0.92	1985	0.27	1
AUC, area under the curve; BAFF, B-cell activating factor; CI, confidence interval; Gd-IgA1, galactose-deficient IgA1; HR, Hazard ratio; IgAN, Immunoglobulin A nephropathy

Gd-IgA1 as an independent risk factor for IgAN recurrence post-KT

Based on the optimal cutoff values of Gd-IgA1, BAFF, and APRIL at 1–6 months post-transplantation, patients were stratified into high and low-risk groups based on each biomarker. Univariate and multivariate Cox regression analyses were conducted for the three biomarkers, along with the patient ages and donor types. As shown in Table 3, Gd-IgA1 levels at 1–6 months post-transplantation were identified as an independent risk factor for IgAN recurrence. Patients with Gd-IgA1 levels ≥ 4.2 µg/mL had a hazard ratio (HR) of 25.38 (95% CI, 2.5–257.88, p = 0.006) for IgAN recurrence compared to those with levels < 4.2 µg/mL. Additionally, BAFF levels at 1–6 months post-transplantation appeared to be a protective factor against IgAN recurrence (HR, 0.03; 95% CI, 0–0.48; p = 0.013). Patients with BAFF levels ≥ 933 (pg/mL) experienced a 97% reduction in the risk of IgAN recurrence post-transplantation.

Table 3

Univariate and multivariate COX regression analyses of Gd-IgA1, BAFF, and APRIL at 1–6 months after transplantation to predict IgAN recurrence
Variable	Univariate			Multivariate
Variable	HR	95% CI	p	HR	95% CI	P
Age	0.93	0.86–1.01	0.068	0.97	0.76–1.25	0.838
Type of Donor, Living	3.16	0.78–12.71	0.106
Gd-IgA1, ≥ 4.2(µg/mL)	9.2	2.18–38.91	0.003	25.38	2.5–257.88	0.006
BAFF, ≥ 933(pg/mL)	0.12	0.03–0.49	0.003	0.03	0–0.48	0.013
APRIL, ≥ 1791(pg/mL)	6.52	1.31–32.5	0.022	7.06	0.36–137.21	0.197
BAFF, B-cell activating factor; CI, confidence interval; Gd-IgA1, galactose-deficient IgA1; HR, Hazard ratio; IgAN, Immunoglobulin A nephropathy

This study demonstrated that Gd-IgA1 can be used as a biomarker to predict the risk of IgAN recurrence in a population of patients receiving kidney transplants in China. The risk prediction worked well through the first 2 years post-transplantation. A Gd-IgA1 level ≥ 4.2 (mg/mL) at 1–6 months post-transplantation was independently associated with an increased risk of IgAN recurrence.

The differences in post-transplantation serum Gd-IgA1 levels between recurrent and non-recurrent IgAN recipients was influenced by two factors. First, most patients with recurrence showed higher Gd-IgA1 levels than those without recurrence before transplantation. Second, while Gd-IgA1 levels in most patients with recurrence remained high, it dropped immediately in most recipients without recurrence after transplantation, even if they were at higher levels before transplantation. There are several explanations for this. For those without recurrence, the serum Gd-IgA1 and related immune complexes were subject to more efficient absorption and degradation once circulated inside the healthy donor kidney. In patients with recurrence, the donor kidneys were not capable of absorbing or degrading circulating Gd-IgA1 and related immune complexes. Further, patients with lower risk might be more responsive to IS treatment, resulting in reduced Gd-IgA synthesis within first year of transplant, while patients with high risk could be less responsive to IS treatment and continue to produce higher amounts of serum Gd-IgA1. The discrepancy in Gd-IgA1 levels between patients with and without recurrence seemed to diminish after 24 months, indicating that the accumulated risk of IgAN recurrence may manifest as the precipitation of Gd-IgA1 immune complexes in the glomerular mesangium rather than solely as the serum Gd-IgA1 concentration.

In 2015, Berthelot et al. first reported the usefulness of serum Gd-IgA1 levels in predicting IgAN recurrence post-KT and that patients with recurrence had significantly higher pre-transplant serum Gd-IgA1 levels than those without recurrence (15). However, Berthoux et al. showed that pre-transplant serum Gd-IgA1 levels could not predict the IgAN recurrence risk (16). Temurhan and Park investigated the correlation between post-kidney transplantation biomarker levels and IgAN recurrence, discovering that, at the time of the biopsy, patients with recurrence exhibited significantly higher levels of Gd-IgA1 than those without recurrence (17, 18). A meta-analysis also supported the relationship between post-KT Gd-IgA1 levels and IgAN recurrence while finding no association between pre-transplant Gd-IgA1 levels and the risk of recurrence (19).

We also investigated whether serum APRIL, BAFF, and sCD89 concentrations could predict the risk of recurrence. Genome-wide association studies have provided significant support for the role of APRIL in the pathogenesis of IgAN (20–25). APRIL can increase the production of Gd-IgA1 in the lymphocytes of patients with IgAN (26, 27). According to Martín-Penagos et al., APRIL levels in serum 6 months post-KT and the average levels within 3 years after KT were significantly higher in patients with IgAN recurrence compared to those without recurrence (28). Our data confirmed the difference in APRIL levels between patients with and without recurrence 1–6 months post-transplantation, but no differences were observed in later time periods. This suggests that, in patients with high risk, elevated APRIL levels in the early stages might contribute to maintaining elevated levels of Gd-IgA1, thereby increasing the risk of IgAN recurrence.

BAFF, which shares high homology with the APRIL protein, is integral to the conversion and expression of IgA1 antibodies. Several studies have implicated high levels of BAFF in the development of IgAN (29–31). Conversely, another report showed lower BAFF levels in patients with IgAN (32). This was also observed in the present study; patients in the IgAN recurrence group had significantly lower levels of BAFF at 1–6 months and 6–12 months post-transplantation than patients without recurrence. Serum BAFF ≥ 933 pg/mL at 1–6 months post-transplantation was identified as a protective factor against IgAN recurrence. We do not have a good explanation for this observation, and we would like to emphasise that more data are required to validate this.

CD89, also known as IgA Fc receptor, is expressed in human bone marrow cells but not in glomerular cells. sCD89 is the soluble free form of the CD89 receptor shed by myeloid cells, and it can bind to IgA and form an immune complex. Studies have indicated that the serum sCD89 concentration can predict disease progression in IgAN (33, 34), while IgA-sCD89 complexes can predict the IgAN recurrence risk after kidney transplantation (15). However, our data did not reveal any association between sCD89 levels and the risk of IgAN recurrence. All patients showed a significant decrease in serum sCD89 levels post-transplantation with no differences between the recurrent and non-recurrent groups. This general decrease in sCD89 levels after kidney transplantation might be caused by the effects of immune suppressors. However, in this study we did not analyse the levels of serum immune complexes of Gd-IgA1-sCD89 or Gd-IgA1-IgG, which might better reflect the IgAN recurrence risk.

This study has some limitations. Firstly, being a retrospective study, there is a possibility of introducing patient selection bias. Secondly, since the sample size was considerably small, the conclusions require further validation in a larger patient cohort through prospective studies. Thirdly, the follow-up duration of our study was relatively short for a disease that progresses as slowly as IgAN. Longer follow-up might affect the findings. Lastly, since all patients were of Han Chinese descent, further validation is necessary to apply these findings to other populations.

In summary, this retrospective study involving a small number of patients with IgAN over a 5-year period has shown that serum Gd-IgA1 levels can effectively predict the risk of IgAN recurrence as early as in the first 1–6 months after kidney transplantation, providing a sufficient time window for intervention to reduce the risk of recurrence. Immediate decreases in the Gd-IgA1 concentration in patients without recurrence after kidney transplant seem to be an indicator for a low IgAN recurrence risk.

APRIL

proliferation-inducing ligand

AUC

area under the curve

BAFF

B-cell activating factor

confidence interval

Gd-IgA1

galactose-deficient IgA1

IgAN

IgA nephropathy

IQR

interquartile range

kidney transplantation

ROC

receiver operating characteristic

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University (Approval No.: [2023]169) and conducted in accordance with the principles of the Helsinki Declaration.

Consent for publication

Not applicable

Availability of data and materials

The data that support the findings of this study are available in the article.

Competing interests

The laboratory testings of Gd-IgA1, BAFF, APRIL and sCD89 were supported by Beijing BFR Gene Diagnostics Co.,Ltd., without any financial link. Xiangjun Liu, Xiaolin Yu, and Wengen Chen are employees of Beijing BFR Gene Diagnostics Co., Ltd. The authors declare no other conflicts of interest related to this study.

Funding

This study did not receive any external funding support.

Authors' contributions

Changxi Wang, Ronghai Deng, and Xiangjun Liu handled study design and project administration; Xiaolin YU and Wengen Chen conducted biomarker testing and data analysis; Xinhua Chang, Zehuan Chen, Qianyu Ye, Bowen Xu, Yifang Gao, Suxiong Deng, and Wengen Chen carried out the investigation; Xiangjun Liu and Wengen Chen drafted the manuscript; and all authors reviewed and edited the manuscript, and have approved the final version.

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No competing interests reported.

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Efficacy of galactose-deficient IgA1 as a biomarker for predicting IgA nephropathy recurrence after kidney transplantation: a retrospective case-control study

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Abstract

Background

Methods

Results

Conclusions

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Background

Methods

Study population

Immunosuppressive regimen

IgAN diagnosis

Laboratory tests

Statistical analysis

Results

Patient characteristics

Biomarker differences in patients with and without IgAN recurrence after KT

Predictive value of biomarkers for IgAN recurrence after KT

Gd-IgA1 as an independent risk factor for IgAN recurrence post-KT

Discussion

Conclusions

Abbreviations

Declarations

References

Additional Declarations

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