Recurrence of immune complex and complement-mediated membranoproliferative glomerulonephritis in kidney transplantation
In a multicenter cohort of 220 kidney transplant recipients with native MPGN, one-quarter developed disease recurrence in the allograft, with recurrence most frequent in complement-mediated disease and in patients with dysproteinemia.
Background
Membranoproliferative glomerulonephritis (MPGN) is a histologic pattern of glomerular injury arising from several etiologies. Few studies had comprehensively analyzed MPGN recurrence after kidney transplantation according to the current classification system distinguishing immune complex-mediated from complement-mediated disease.
Study design
Investigators assembled a multicenter, retrospective cohort of 220 kidney graft recipients with biopsy-proven native kidney disease due to MPGN, transplanted between 1981 and 2021 across 11 hospitals. The group comprised 34 complement-mediated and 186 immune complex-mediated cases. Main outcomes were time to kidney failure, time to recurrence, and disease remission after recurrence.
Key findings
A total of 81 patients (37%) reached kidney failure over a median follow-up of 79 months, with rejection episodes and disease recurrence being the main predictors. Recurrence occurred in 54 patients (25%) at a median of 16 months after transplantation; incidence was higher in patients with dysproteinemia (67%) and complement-mediated MPGN (62%), and complement-mediated disease emerged as an independent predictor of recurrence. Among those with recurrence, determinants of failure to remit were early recurrence (under 15 months), eGFR below 30 mL/min/1.73 m2, and serum albumin below 3.5 g/dL at recurrence.
Clinical implications
Roughly one in four patients transplanted for MPGN develop clinical recurrence in the allograft, particularly those with complement-mediated disease or associated dysproteinemia. Because outcomes with currently available therapies are heterogeneous, the authors emphasize the need for more effective and individualized treatments, a gap increasingly addressed by emerging complement-targeted agents.
Category
Transplant
Source
Nephrology Dialysis Transplantation
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