Recurrent Membranoproliferative Glomerulonephritis After Kidney Transplantation: Risk Factors and Impact on Graft Survival

Abstract

Background Membranoproliferative glomerulonephritis (MPGN) is an uncommon cause of end-stage renal disease (ESRD). Recurrence rates after transplantation range from 11.8% to 18.9% after 5 and 15 years, respectively. This study aimed to assess the risk factors of MPGN recurrence after kidney transplantation and its impact on graft survival. Material/Methods This was a single-center retrospective cohort, including renal transplant recipients older than 18 years, with a diagnosis of MPGN in native kidneys. Data were obtained from medical records during the first 5-year post-transplant follow-up. Primary endpoints were graft function and survival. Secondary endpoints were MPGN recurrence risk factors and these cases’ clinical, laboratory, and histological features. Results Twenty-eight patients were included; the majority male (60.7%), with a mean age of 24.0±9.4 years. At MPGN native diagnosis, all patients presented proteinuria, with C3 consumption in 42.9%. Histological analysis showed 13 (42.9%) MPGN type I and 5 (17.9%) type II, with no cases of type III. MPGN recurrence occurred in 7 (25.0%) patients; 85.7% were male, 57.1% were recipients from a living donor, all presenting nephrotic syndrome and hematuria, with C3 consumption in 71.4%. The graft function was similar between the groups. Two (28.6%) patients progressed to graft failure in the recurrence group, and 1 died with a functioning graft. Conclusions The MPGN recurrence rate was 25%, most of them recipients of kidneys from living donors. Nephrotic syndrome and C3 consumption were frequent at recurrence. The graft function was similar between the groups, and the 5-year graft survival rate in the recurrence group was higher than in other studies.

Updates on C3 Glomerulopathy in Kidney Transplantation: Pathogenesis and Treatment Options

“…In line with these observations, another study showed that in patients with MPGN as a primary disease, the presence of nephrotic syndrome and complement consumption in a native kidney predicts a more severe disease. In this analysis, the impact of MPGN was lower compared to the literature (between 11.8% and 18.9%), probably due to the maintenance therapy with corticosteroids after KTs [21].…”

Post-Transplant Glomerulonephritis: Challenges and Solutions

“… 38 , 39 A retrospective study by our group, including recipients of kidney transplantation with CKD secondary to MPGN, showed a recurrence rate of 25%, most recipients of kidneys from living donors, like that observed in other studies. 40 The MPGN recurrence rate is higher among patients with complement-mediated MPGN than immune complex-mediated MPGN. 41 The recurrence rate of DDD is high, reaching 100% in some studies, with a 5-year rate of graft failure of 50%.…”