Abstract: TH-PO911
Phospholipase A2 Receptor Antibody (PLA2Rab) Epitope Spreading (ES) Associates with Recurrent Membranous Nephropathy (MN)
Session Information
- Transplantation: Donation and Access
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Amer, Hatem, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- El Ters, Mireille, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- Beck, Laurence H., Boston University, Boston, Massachusetts, United States
- Fervenza, Fernando C., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
Background
Anti-PLA2Rab ES has been associated with higher anti-PLA2R ab titers, more severe disease, greater likelihood of progression to ESRD, and need for higher doses of Rituximab. The objective of this study was to determine if epitope spreading associates with recurrent MN post kidney transplant (KTx).
Methods
Pre-transplant serum from 23 KTx recipients with ESKD due to MN was analyzed by ELISA and Western blot for presence of anti-PLA2R abs and ES. Recurrence was diagnosed by protocol biopsies and proteinuria measurements.
Results
Age 50.9± 12.8 year, 65.2% males, 82.6% received a kidney from a living donor, 43.5% were preemptive transplants. There were no demographic differences between those with positive anti-PLA2Rab or not, nor those with ES vs. not. PLA2Rab was detected in 14 (60.9%) patients. Epitope spreading was present in 6/14 (42.9%) of those: 100% if PLA2Rab>150RU, 50% if >50 <150 RU, and 20% if < 50RU. One was positive for CTLD1-3 and one for CTLD4-8 with the remainder co-positive. PLA2Rab+ patients were more likely to recur HR 8.8 (1.13, 68.00). In PLA2Rab+, ES associated with increased risk of recurrence HR 15.2 (1.7, 133.3) unadjusted and 9.8 (1.03, 94.1) adjusted for PLA2Rab level. Seven patients required therapy with Rituximab for recurrent MN with no graft loses.
Conclusion
ES of PLA2Rab associates with a higher likelihood of post KTx recurrence of MN and may be useful to determine in those with PLA2Rab < 150 RU.
Funding
- Clinical Revenue Support