Recurrence of membranous nephropathy after kidney transplantation: a multicenter retrospective cohort study
A large international transplant cohort found membranous nephropathy recurs in about one-third of patients within 10 years, with high pre-transplant PLA2R antibody levels strongly predicting recurrence and rituximab improving the odds of remission.
Study design
Within the Post-Transplant Glomerular Disease Consortium, investigators screened 22,921 patients across three continents and analyzed 194 recipients transplanted for biopsy-proven membranous nephropathy, examining recurrence rate, risk factors, and treatment response.
Key findings
Cumulative recurrence incidence was 31% at 10 years post-transplant. Faster pre-transplant progression to kidney failure and, most strongly, elevated pre-transplant anti-PLA2R antibodies (hazard ratio 18.58) predicted recurrence. Patients treated with rituximab for recurrence were more likely to achieve remission than those receiving renin-angiotensin-aldosterone system inhibition alone.
Clinical implications
Measuring serum anti-PLA2R antibodies shortly before transplantation can risk-stratify candidates for recurrence, and rituximab is a reasonable first choice when recurrent disease develops.
Category
Transplant
Source
American Journal of Transplantation
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