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Kidney Week

Abstract: PO1783

Evolution of Resolving Clinical and Histological Changes in Kidney Grafts from a Donor with Primary Membranous Nephropathy

Session Information

Category: Trainee Case Report

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Hermida Lama, Evelyn, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Garcia, Adriana, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Rodriguez-Espinosa, Diana, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Montagud-Marrahi, Enrique, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Quintana, Luis F., Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  • Andújar, Alicia Molina, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
Introduction

Primary membranous nephropathy (PMN) is an autoimmune disease limited to the kidney that is characterized by the presence of circulating PLAR2 antibodies in 70% of the cases and usually positivity for PLA2R and IgG4 by immunohistochemistry (IHC) staining. We report the clinical and histopathological evolution of two recipients from a donor after circulatory death (DCD) with PMN.

Case Description

DCD Maastricht III was a 63-year-old male, died from respiratory failure. His serum creatinine was 0.9 mg/dL, no urinalysis was performed. The Remuzzi-score preimplant-biopsy was 1 point for the right kidney (recipient A) and 2 points for the left kidney (recipient B). Thymoglobulin as induction therapy, with tacrolimus, mycophenolate mofetil, and prednisone as a maintenance immunosuppressive regimen for both recipients.
A kidney biopsy was performed two weeks after in recipient A due to delayed graft function. It was compatible with MN with both PLA2R and IgG4 subepithelial deposits. The donor’s kidneys biopsies were reexamined, revealing MN, with high intensity for PLA2R and IgG4 in IHC.
Recipient B 3rd-month protocol allograft biopsy revealed histology compatible with MN, without the presence of PLA2R and IgG4 in IHC.
At one year follow-up, both recipients maintain graft function and the protocol biopsies showed a negativization of IgG4 but the persistence of PLA2R in IHC, this positivity was attributed to the variability inherent to the technique.

Discussion

Given the reversal of PMN changes in the grafts, it is probably safe to transplant a patient from an asymptomatic donor with PMN as long as he maintains unaltered renal function. Observation of IgG4 immune complexes is more accurate to assess histological remission.