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Abstract: TH-PO485

A Large International Registry Study on Membranous Nephropathy Recurrence Post-Transplant

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Hullekes, Frank E., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Cravedi, Paolo, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Riella, Leonardo V., Massachusetts General Hospital, Boston, Massachusetts, United States

Group or Team Name

  • The Post-Transplant Glomerular Disease (TANGO) Consortium
Background

Membranous nephropathy (MN) is one of the major causes of nephrotic syndrome in adults worldwide and frequently recurs after transplant. Disease activity is driven by underlying autoimmune processes, leading to circulating autoantibodies directed against glomerular podocyte antigens. Multiple target proteins have been associated with MN in the past decade, including PLA2R and THSD7A. No clear clinical and immunological characteristics have been associated with recurrent MN, as most studies were single-centers and underpowered.

Methods

Through the Post-Transplant Glomerular Disease (TANGO) Consortium, we initiated a multi-center retrospective cohort study aiming to investigate MN recurrence after transplant. Adult patients with biopsy-proven MN, transplanted between 2005-2018 were identified to study the incidence of recurrent MN, any potential predictors, and treatment regimens. Serum samples were retrieved for a subset of patients to identify a potential role of podocyte autoantibodies in predicting and detecting recurrence.

Results

22,921 patients were screened by 16 transplant centers across three continents. Among these, 188 kidney transplant patients with biopsy-proven MN were included for data analysis. The cumulative incidence for recurrence was 30% (95% CI: 16-42) at 10 years post-transplant. The median time to diagnose recurrence was 4.9 years [IQR: 2.2-7.6]. Graft survival rates were similar between patients with and without a recurrence. Age at diagnosis, race, time from diagnosis to end-stage kidney disease (ESKD), BMI, time on dialysis, HLA mismatch, living donor, and early steroid withdrawal were not associated with recurrence.

Conclusion

Through the TANGO-Consortium, we identified the largest cohort to date of MN transplant patients. MN recurred in 30% but did not impact graft survival. Ongoing analysis of pre- and post-transplant serum samples will assess the correlation between autoantibody titers and risk of recurrence.

Cumulative incidence of MN recurrence