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Kidney Week

Abstract: PO2551

Phospholipase A2 Receptor Antibody Level Directed Management of Membranous Glomerulopathy After Transplant

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Agha, Irfan, Dallas Renal Rroup, Dallas, Texas, United States
  • Ilahe, Amna, Dallas Renal Rroup, Dallas, Texas, United States
  • Simon, Silvi, Dallas Renal Rroup, Dallas, Texas, United States
  • Nadella, Rama, Dallas Renal Rroup, Dallas, Texas, United States
  • Mahbod, Diana, Dallas Renal Rroup, Dallas, Texas, United States
  • Dickerman, Richard, Methodist Dallas Medical Center, Dallas, Texas, United States
Introduction

MN can recur after transplantation. Patients with high PLA2R Ab are at higher risk. There is equipoise on how to manage these patients. We present two cases to highlight PLA2R Ab level directed approach to management.

Case Description

Case 1:
35 YO AA female with MN diagnosed in 2013. Failed cytotoxic therapy and started RRT. Received a DD kidney transplant in Sep 2018. Given Thymoglobulin, tacrolimus, mycophenolate and prednisone. Pretransplant PLA2R titer 1:2560 by IIF. Titer serially monitored. After an initial decline, titer increase with precipitation of proteinuria noted. Biopsy confirmed early recurrent MN. Treated with 2 doses of Rituximab. Subsequent titers dropped with complete remission.

Case 2:
65 YO W male with biopsy demonstrated MN (2015), on RRT since 2017 underwent DD kidney transplant in May 2019. Given Thymoglobulin and maintained on tacrolimus, mycophenolate and prednisone. Pretransplant PLA2 R Ab level was 164 RU/ml by EIA with 3.5 g/g of protein. His PLA2R Ab levels dropped and proteinuria rapidly & durably resolved after transplant. One year out, his PLA2R Ab is at 24 RU/ml with 0.11 g/g protein in the urine and a creatinine of 1.2 mg/dl.

Discussion

High PLA2 R Ab at the time of transplant is a significant risk factor for recurrent MN.
PLA2R Ab levels should be monitored to direct care: decreasing PLA2R Ab should be followed conservatively. If Ab levels increase or proteinuria develops, perform biopsy to confirm diagnosis and initiate therapy expeditiously.
PLA2R Ab levels should be monitored post treatment to ensure resolution.
This approach allows stratification and directed therapy of patients with MN undergoing transplantation and avoids over treatment.

Case 1

Case 2