Clinicopathologic features and prognosis of membranous nephropathy after renal allografting / 中华器官移植杂志

ABSTRACT

Objective:To explore the clinicopathologic features and renal prognosis of patients with post-transplant membranous nephropathy (MN).Methods:Patients with allograft biopsy-proven MN were reviewed retrospectively and divided into unknown etiology group (A, n=12) and recurrent membranous nephropathy (rMN) group (B, n=7). Their clinicopathological data and renal prognosis were assessed and compared.Results:No differences existed in the proportion of living-related donor or post-transplant allograft function. Group B had recurrence at 16.4 months after transplantation and it was significantly shorter than group A. Allograft impairment manifested as proteinuria, nephrotic syndrome and/or renal insufficiency in both groups. The positive rate of serum anti-PLA2R antibody and renal PLA2R staining was significantly higher in group B than that in group A. Similarly, the intensity of IgG4 subtype staining was also stronger in group B than that in group A. The 5-year cumulative renal survival rates from end-stage renal disease (ESRD) were 77.8% and 66.7% in groups A and B respectively. No significant inter-group difference existed in renal prognosis.Conclusions:Anti-PLA2R antibody plays an important role in the recurrence of rMN after renal allografting. PLA2R staining is useful for detecting primary disease and its sensitivity is higher than that of serum anti-PLA2R antibody. Rituximab is an effective treatment for post-transplant MN. Follow-up studies with a larger sample size are required for further verification.