Utility of MEST and MEST-C Scoring in IgA Nephropathy in Kidney Transplantation: A Mini Review

Abstract

IgAN is a major cause of end-stage kidney disease (ESKD) leading to kidney transplantation in a significant proportion of patients. However, its recurrence in transplanted kidneys can lead to graft loss. The rate of graft loss attributable to IgAN after transplantation is variably reported in different retrospective cohorts. Previous reports describe recurrence rates of 22-58% with a 1.3% to 16% rate of graft loss. Accurate diagnosis and prediction of graft loss are important for planning effective therapies to improve graft survival in IgAN post transplantation. The Oxford classification using MEST and MEST-C in native kidney disease IgAN has been established for well over a decade. We propose investigating if this classification system can be applied to kidney allografts to standardize the categorization of transplant IgAN. More importantly, successful use of this classification could assist in selecting patients for prospective interventional trials and defining better treatments. In this literature review, we explore the available literature on the Oxford classification and its utility in describing the disease and predicting graft loss in IgA nephropathy within the context of kidney transplantation.