Recurrence of membranous nephropathy after kidney transplantation: A multicenter retrospective cohort study

Area of Science:

• Nephrology
• Transplantation Immunology

Background:

• Membranous nephropathy (MN) is a major cause of kidney failure and commonly recurs post-kidney transplant.
• Existing data on MN recurrence risk factors and treatment efficacy are limited, often from small studies.

Purpose of the Study:

• To investigate the rate, risk factors, and treatment response of MN recurrence after kidney transplantation.
• To identify predictors of MN recurrence and evaluate therapeutic strategies.

Main Methods:

• Retrospective multicenter cohort study involving 194 kidney transplant recipients with biopsy-proven MN.
• Analysis of patient data from the Post-Transplant Glomerular Disease Consortium across three continents.
• Evaluation of risk factors including disease progression rate and pre-transplant anti-phospholipase A2 receptor (PLA2R) antibody levels.

Main Results:

• The cumulative incidence of MN recurrence was 31% at 10 years post-transplant.
• Faster progression to end-stage kidney disease (HR, 0.55) and elevated pre-transplant anti-PLA2R antibodies (HR, 18.58) significantly increased recurrence risk.
• Rituximab treatment showed a higher likelihood of remission compared to renin-angiotensin-aldosterone system inhibition alone.

Conclusions:

• MN recurrence is a significant concern, affecting approximately one-third of kidney transplant recipients within a decade.
• Pre-transplant anti-PLA2R antibody levels and disease progression rate are crucial for risk stratification.
• Rituximab appears to be an effective treatment for MN recurrence, improving remission rates.