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De novo membranous nephropathy and antibody-mediated rejection in transplanted kidney
Kazuho Honda1, Shigeru Horita, Daisuke Toki
1Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan. honda@research.twmu.ac.jp
Background:
The etiology of de novo membranous nephropathy (MN) after kidney transplantation is still uncertain. Immunological response to various allograft antigens is speculated to be a candidate for the etiology.
Methods:
Seventeen patients with post-transplant de novo MN were studied clinically and pathologically in comparison with control post-transplant patients without MN. Double immunofluorescent staining was performed to identify the presence of donor-specific human leukocyte antigen (HLA) combined with IgG in the deposits on glomerular capillary walls.
Results:
De novo MN occurs in relatively late period after transplantation (102.1 ± 68.3 months), presenting various degree of proteinuria. Histological findings associated with antibody-mediated rejection (AMR), such as peritubular capillaritis and C4d deposition in peritubular capillary, were more frequently observed in the patients with de novo MN than the non-MN control patients. Donor-specific antibody (DSA) was detected in five patients at the time of biopsy. In one case of de novo MN with DSA, a donor-derived HLA was identified in the subepithelial deposits on the glomerular capillary walls combined with IgG deposition.
Conclusions:
DSA and AMR might play some roles for the pathogenesis in some patients with de novo MN after kidney transplantation.
Insights
De novo membranous nephropathy (MN) after kidney transplant may involve immune responses. Donor-specific antibodies and antibody-mediated rejection are implicated in some cases of post-transplant MN.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pathology
Background:
- The causes of de novo membranous nephropathy (MN) following kidney transplantation remain unclear.
- Immune responses targeting allograft antigens are a suspected factor in MN development.
Purpose of the Study:
- To investigate the potential role of immunological factors in the pathogenesis of de novo membranous nephropathy after kidney transplantation.
- To compare clinical and pathological features of patients with post-transplant de novo MN against controls.
Main Methods:
- Clinical and pathological evaluation of 17 patients with post-transplant de novo MN and control patients.
- Double immunofluorescent staining to detect donor-specific human leukocyte antigen (HLA) and IgG in glomerular deposits.
Main Results:
- De novo MN manifested late post-transplant (mean 102.1 months) with variable proteinuria.
- Antibody-mediated rejection (AMR) markers (peritubular capillaritis, C4d deposition) were more common in de novo MN patients.
- Donor-specific antibody (DSA) was found in 5 patients; one case showed donor HLA and IgG in subepithelial deposits.
Conclusions:
- Donor-specific antibodies (DSA) and antibody-mediated rejection (AMR) may contribute to the pathogenesis of de novo membranous nephropathy in select kidney transplant recipients.
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