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Updated: Jun 5, 2026
Mouse Kidney Transplantation: Models of Allograft Rejection
Published on: October 11, 2014
Allograft failure in kidney transplant recipients with membranoproliferative glomerulonephritis
Joseph R Angelo1, Cynthia S Bell, Michael C Braun
1Department of Pediatrics, The University of Texas Medical School at Houston, USA.
Background:
Membranoproliferative glomerulonephritis types I (MPGN-I) and II (MPGN-II) are rare diseases that in limited case series have been reported to recur frequently in kidney transplants and have a negative impact on allograft survival.
Study Design:
Retrospective database review.
Setting & Participants:
189,211 primary kidney transplants in the United Network for Organ Sharing (UNOS) database from September 1987 to May 2007.
Predictor Or Factor:
MPGN-I (811 patients; 0.4%), MPGN-II (179 patients; 0.1%), other GN (58,129 patients; 30.7%), and all other diagnoses (130,092 patients; 68.7%).
Outcomes:
Death-censored and non-death-censored allograft survival.
Results:
Compared with controls, patients with MPGN-I and MPGN-II were significantly younger at the time of transplant, with a median age of 36 and 27 years compared with 44 years in the GN group and 46 years in all other disease groups, respectively (all P < 0.001). Mortality in patients with MPGN-I (8.8%) was significantly lower compared with the GN (11.3%; P = 0.02) and other disease (16.6%; P < 0.001) populations and lower in those with MPGN-II (9.5%) compared with the other disease (16.6%; P = 0.01) population. Graft failure rates were significantly higher in the MPGN-I (44.5%) cohort, but not in the MPGN-II (45.3%) cohort compared with the GN (38.0%) population (P < 0.001 and P = 0.05, respectively); neither MPGN cohort differed from the other disease (43.0%) population (P = 0.4 and P = 0.5). Overall, 10-year death-censored graft survival was similar for MPGN-I (56.2%) and MPGN-II (57.5%); both were significantly worse than for GN (65.2%; P < 0.001 and P = 0.003, respectively), and only MPGN-I was significantly worse than the other disease (60.0%) population (P = 0.004). Of allograft failures with a reported cause, disease recurrence was the primary cause in 36 (14.5%) MPGN-I and 18 (29.5%) MPGN-II transplant recipients and was significantly higher compared with 879 (6.6%) GN and 1,319 (4.4%) all-other-disease recurrence failures (P < 0.001).
Limitations:
Limited pretransplant clinical and biopsy data.
Conclusions:
A diagnosis of MPGN-I or MPGN-II has a significant negative impact on overall primary allograft survival compared with other forms of glomerulonephritis, whereas only MPGN-I has a significant, but modest, negative effect compared with other causes of end-stage renal disease.
Insights
Membranoproliferative glomerulonephritis types I and II (MPGN-I and MPGN-II) negatively impact kidney transplant survival, with MPGN-I showing worse outcomes than other glomerulonephritis types. Disease recurrence is a primary cause of allograft failure in MPGN patients.
Area of Science:
- Nephrology
- Transplantation Immunology
- Glomerular Diseases
Background:
- Membranoproliferative glomerulonephritis types I (MPGN-I) and II (MPGN-II) are rare kidney diseases.
- These conditions are associated with high rates of recurrence in kidney allografts.
- Recurrence of MPGN-I and MPGN-II negatively affects long-term kidney transplant survival.
Purpose of the Study:
- To evaluate the impact of MPGN-I and MPGN-II on primary kidney allograft survival.
- To compare outcomes of kidney transplantation in patients with MPGN-I and MPGN-II versus other glomerulonephritis (GN) and end-stage renal disease (ESRD) etiologies.
Main Methods:
- Retrospective analysis of the United Network for Organ Sharing (UNOS) database.
- Included 189,211 primary kidney transplants performed between September 1987 and May 2007.
- Patients were categorized into MPGN-I, MPGN-II, other GN, and all other diagnoses groups.
Main Results:
- MPGN-I and MPGN-II patients were significantly younger at transplant compared to controls.
- Graft failure rates were higher in MPGN-I and MPGN-II cohorts compared to the other GN group.
- Disease recurrence was a significantly more frequent cause of allograft failure in MPGN-I and MPGN-II recipients than in other groups.
Conclusions:
- MPGN-I and MPGN-II diagnoses significantly impair primary allograft survival compared to other forms of glomerulonephritis.
- MPGN-I demonstrates a significant, albeit modest, negative effect on survival compared to other ESRD causes.
- Limited pretransplant clinical and biopsy data represent a limitation for definitive conclusions.
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