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Post Transplant Membranous Nephropathy: A 10-year Single-Centre Experience
Payal Gaggar1, Rahul R Nair1, Avinash Pratapsingh Thakur1
1Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India.
Indian Journal of Nephrology
|September 2, 2025
Summary
Membranous nephropathy after kidney transplant is rare but serious. Early diagnosis and targeted treatment, especially for concurrent rejection, are crucial for preserving graft function and improving patient outcomes.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pathology
Background:
- Membranous nephropathy (MN) can occur after kidney transplantation, either as recurrence of the original disease or as a new (de novo) onset.
- This condition significantly impacts long-term graft survival and patient prognosis.
Observation:
- A retrospective analysis of 530 kidney allograft biopsies over 10 years identified five cases of MN (approximately 1%).
- Four cases were de novo MN (0.8%), and one was recurrent MN.
- In de novo MN cases, 75% had concurrent antibody-mediated rejection (AMR), and 25% tested positive for anti-phospholipase A2 receptor (PLA2R) antibodies.
Findings:
- Treatment strategies included plasmapheresis, intravenous immunoglobulin, and rituximab.
- Outcomes varied, with two patients stabilizing, one experiencing graft loss, and one achieving complete remission.
- The recurrent MN case, diagnosed 10 years post-transplant, showed a partial response to rituximab.
- Concurrent AMR in de novo MN was associated with a 33% graft loss rate.
Implications:
- Antibody-mediated rejection significantly influences the prognosis of de novo MN post-transplantation.
- Personalized treatment approaches, tailored to the specific etiology and presence of rejection, are essential.
- Prompt diagnosis and individualized management strategies are critical for optimizing outcomes in post-transplant membranous nephropathy.
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