Kidney Week

Abstract: SA-PO532

Characteristics of Donor Transmitted Membranous Nephropathy in Kidney Transplantation

Session Information

• Immunosuppression, Disease Recurrence, and Malignancy
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• Otsuka, Yasuhiro, Nagoya Daini Red Cross Hospital, Nagoya, Aichi-Ken, Japan

Yasuhiro Otsuka,

• Watarai, Yoshihiko, Nagoya Daini Red Cross Hospital, Nagoya, Aichi-Ken, Japan

Yoshihiko Watarai,

• Takeda, Asami, Nagoya Daini Red Cross Hospital, Nagoya, Aichi-Ken, Japan

Asami Takeda,

Background

Donor transmitted membranous nephropathy (MN) is unique entity that shows histological features of MN even though donor urinalysis is negative for protein before kidney transplantation (KTx). Donor transmitted MN is rarely seen in KTx, but its prognosis and histological changes are unclear.

Methods

Retrospective data were collected from 2002 to 2016. Out of 1113 KTx cases, eight patients were diagnosed with donor transmitted MN by 1 hour biopsy. All eight cases were living KTx, and posttransplant renal function and urinary protein of both donor and recipient were analyzed. Protocol renal allograft biopsies were performed one hour, three weeks, and one year after KTx, and light microscopy, immunofluorescent study for IgG, C3, C4d, and IgG subclass, and electron microscopy were performed.

Results

Donor age was 61.1 ± 13.1 years, and four were male. Urinalysis was negative for protein in all eight donors. Donor eGFR and urinary albumin creatinine ratio (UACR) before KTx was 83.0 ± 11.2 ml/min/1.73m² and 38.0 ± 38.7 mg/g. Donor eGFR and UACR one year after KTx was 51.5 ± 9.1 ml/min/1.73m² and 3.5 ± 0.9 mg/g. Donor follow up period was 43.1 ± 43.9 months, latest eGFR and urinary protein was 50.6 ± 10.1 ml/min/1.73m² and 0.08 ± 0.12 g/day. Recipient age was 38.6 ± 7.0 years, five were male, and all eight cases were ABO compatible KTx. Recipient eGFR and urinary protein one year after KTx was 41.6 ± 11.9 ml/min/1.73m² and 0.14 ± 0.08 g/g. Recipient follow up period was 52.0 ± 43.0 months, latest eGFR and urinary protein was 37.5 ± 6.8 ml/min/1.73m² and 0.11 ± 0.20 g/day. In immunofluorescence study for IgG, one case out of five cases was negative at three weeks biopsy and five out of six was negative at one year biopsy. Four out of five were positive for C4d on capillary wall at one year biopsy. IgG subclass stain revealed that one case was negative for IgG4. By light microscopy, bubbling appearance was observed at one hour and one year biopsy in all available cases. By electron microscopy, stage did not change at one year biopsy except one case from Ehrenreich–Churg stage III to stage IV.

Conclusion

This study suggest that deposition of IgG in donor transmitted MN decreases within one year after KTx. Clinical data showed a good renal function and urinary protein within normal limit at latest follow-up in both donor and recipient.