When the Donor Surprises You: A Case Report

Area of Science:

• Nephrology
• Transplantation immunology
• Pathology

Background:

• Membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults.
• The potential for donor-derived MN in kidney transplantation is a recognized but rare complication.
• Understanding the behavior of donor-derived MN is crucial for recipient management.

Observation:

• Two kidney transplant recipients received grafts from a donor with no known kidney disease.
• Histopathological analysis revealed features consistent with donor membranous glomerulopathy in both recipients.
• Immunofluorescence and immunohistochemistry confirmed IgG4-related donor MN, despite negative anti-PLA2R antibodies.

Findings:

• The first recipient showed persistent stage 1 MN on biopsy but remained without proteinuria.
• The second recipient had stage 1 MN on early biopsy, which resolved by the second year.
• Both recipients maintained stable graft function throughout the follow-up period.

Implications:

• This case series suggests that donor-derived MN may not always lead to graft dysfunction or significant proteinuria.
• It highlights the importance of careful histopathological evaluation in kidney transplant recipients with unexplained renal dysfunction.
• Further research is needed to elucidate the long-term outcomes and management strategies for donor-derived MN.