Abstract: TH-PO580
A Novel Approach to Successfully Prevent Membranoproliferative Glomerulonephritis Recurrence in a High-Risk Transplant Patient
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Murthy, Suresh, Royal Adelaide Hospital, Seacombe Gardens, New South Wales, Australia
- Mcmichael, Lachlan, Royal Adelaide Hospital, Seacombe Gardens, New South Wales, Australia
- Irish, Georgina, Royal Adelaide Hospital, Seacombe Gardens, New South Wales, Australia
- Chang, Sean Haw, SA Pathology, South Australia, Woodville South, South Australia, Australia
- McDonald, Stephen P., Royal Adelaide Hospital, Seacombe Gardens, New South Wales, Australia
- Coates, Patrick Toby, Royal Adelaide Hospital, Seacombe Gardens, New South Wales, Australia
Introduction
Membranoproliferative glomerulonephritis (MPGN) is a particularly challenging primary pathology in kidney transplant patients due to its high rates of recurrence and graft loss. Aggressive or crescentic disease at presentation, low complement levels pre-transplantation, monoclonal gammopathy, live-related transplantation and certain HLA-associated risk factors are predictive of recurrence risk in the allograft. Various strategies have been used to manage such recurrence, but data is limited on pre-emptive management.
Case Description
We report the case of a 63-year-old woman with immune-complex-mediated idiopathic MPGN who had several risk factors for allograft recurrence, receiving a second renal transplant following early recurrence in her first transplant. Rising creatinine and new proteinuria led to biopsy confirmed recurrent disease in her first transplant at Day 76, with return to long term haemodialysis at day 86 despite maximal medical therapy to salvage the graft.
10 years later, she received a second, well matched transplant. Induction immunosuppression included anti-thymocyte globulin at day 0,1,2; plasma exchange at day 3 and rituximab at day 5 and 18. Protocol biopsy at day 79 demonstrated minimal tubulitis and no recurrent primary disease. Another biopsy performed at day 197 due to elevated creatinine following clostridium difficile infection, again demonstrated no recurrent disease. She remains on prednisolone, mycophenolate mofetil and tacrolimus with stable graft function at 7 months.
Discussion
The optimal management of patients with idiopathic MPGN at the time of transplantation is unknown. We demonstrate a new approach with rituximab and plasma exchange for pre-emptive management of a patient with idiopathic MPGN and multiple risk factors for early recurrence. This strategy has been successful in maintaining recurrence-free graft function at 7 months post transplantation