Beneficial Effect of Rituximab in the Treatment of Recurrent Idiopathic Membranous Nephropathy after Kidney Transplantation

Abstract

Background and objectives: Recurrence of the original kidney disease after renal transplantation is an increasingly recognized cause of allograft loss. Idiopathic membranous nephropathy (iMN) is a common cause of proteinuria that may progress to ESRD. It is known that iMN may recur after kidney transplantation, causing proteinuria, allograft dysfunction, and allograft loss. Limited data regarding the frequency and treatment of recurrent iMN are available.Design, setting, participants, & measurements: In this single-center study, all patients who had iMN and were receiving a first kidney transplant were included. We retrospectively assessed the incidence of biopsy-confirmed recurrent iMN and compared clinical characteristics of patients with and without recurrence. In addition, the effect of treatment with rituximab on proteinuria and renal allograft function in patients with recurrent iMN was examined Results: The incidence of recurrent iMN was 44%, and recurrences occurred at a median time of 13.6 months after transplantation. Two patterns of recurrence were identified: Early and late. No predictors of recurrence or disease progression could be identified. Treatment with rituximab was effective in four of four patients in stabilizing or reducing proteinuria and stabilizing renal function.Conclusions: Recurrence of iMN is common even in the era of modern immunosuppression. Rituximab seems to be a valuable treatment option for these patients, although lager studies are needed to confirm our data.

Membranous nephropathy

“…The reason is not clear, but may be associated with donorspecific antibodies (HLA or non-HLA). As with native IMN, some success has been claimed for rituximab in small series, 31 but the numbers are small and RCTs are needed before this agent moves into routine use.…”

Rituximab-Induced Depletion of Anti-PLA2R Autoantibodies Predicts Response in Membranous Nephropathy

“…Rituximab, a chimeric anti-CD20 monoclonal antibody used for anti-B cell therapy, has recently been investigated as a promis-ing agent for the treatment of membranous nephropathy (MN) in the native kidney and for recurrent MN in the allograft. [2][3][4][5][6][7] Treatment response has been assessed by the attainment of a complete or partial clinical remission, whereas other laboratory parameters have not been useful in monitoring therapy.…”

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“…This finding differs from other studies that showed recurrence rates of 10% to 45%. 31 Other studies by Debiec and associates and Kennedy and associates demonstrated recurrence rates of 30% to 45%. 32,33 The difference between these results could be attributed to racial differences and the use of kidney grafts from deceased donors.…”