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Kidney Week

Abstract: PO1904

Recurrent Membranous Post Transplantation: Histopathology, Treatment, and Outcomes

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Gleeson, Sarah, Imperial NHS Healthcare Trust, London, United Kingdom
  • Nikolopoulou, Aikaterini K., Imperial NHS Healthcare Trust, London, United Kingdom
  • Griffith, Megan, Imperial NHS Healthcare Trust, London, United Kingdom
  • Loucaidou, Marina, Imperial NHS Healthcare Trust, London, United Kingdom
  • Willicombe, Michelle, Imperial NHS Healthcare Trust, London, United Kingdom
  • Roufosse, Candice A., Imperial NHS Healthcare Trust, London, United Kingdom
Background

Membranous nephropathy(MN) recurs in 30-45% of transplants. Reported recurrence rates are higher in centres that perform surveillance biopsies. Optimal treatment is unknown. We examined recurrent MN in our cohort in terms of their histopathology, treatment and outcomes.

Methods

Patients with MN as the cause of their ESRF who were later transplanted were identified from an in-house database. Further data was collected from the electronic health record.

Results

36 patients with a diagnosis of MN were transplanted. Mean follow up was 6.4 ± 4.2 years. 41.6% had a rejection episode (mean time from transplant 0.42±0.15 years). Overall there was 22% graft loss (mean time 6.5± 3.7 years), 11% deaths (8.6± 2.3 years from transplant) and 6% deaths with functioning grafts (mean time 6.9± 2.3 years). Mean eGFR at 3 months and 1 year were 48.1 ±18.5 and 48.1±14.5 ml/min.
30/36 patients had at least one biopsy following transplantation. Of those whose biopsies did not show recurrence, the mean time to the most recent biopsy was 2.9± 2.7 years (range 0.02-9.3)
8/36 patients (22%) had recurrent MN, 7 detected on indication biopsy and 1 on surveillance biopsy. The mean time to recurrence was 1.9±1. years (range 0.09-4.46 years). Granular C4d staining of the capillary wall was detected in 6/8 biopsies prompting immunofluorescence and electron microscopy, leading to the diagnosis of recurrent MN. Histological anti-PLA2R staining was positive in 3/8 biopsies. 2/8 patients had donor specific antibodies.
In the 4 patients with clinically significant proteinuria rituximab was used to treat with a complete or partial response in all patients (mean time 22.5±16 months [range 4.4-43.8 months]). There are no significant differences in rejection, graft loss, death or death with functioning graft between those with recurrence and those without recurrence in our cohort.
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Conclusion

Recurrent MN was frequent but not associated with increased allograft failure in our programme, with the use of rituximab in selected cases. Granular C4d staining of the glomerulus in transplant patients with MN could prompt further investigation with immunofluorescence and electron microscopy to look for recurrent disease.