Recurrent Membranoproliferative Glomerulonephritis Type I After Kidney Transplantation

Green, Hefziba; Rahamimov, Ruth; Rozen‐Zvi, Benaya; Pertzov, Barak; Tobar, Ana; Lichtenberg, Shelly; Gafter, Uzi; Mor, Eytan

doi:10.1097/tp.0000000000000459

Cited by 20 publications

(18 citation statements)

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“…Increased risk with live donation has been reported in a number of studies of primary GN, and specifically in IGAN [16–21], FSGS [22–24] and MCGN [25–28]. This is the largest study of primary GN recurrence in transplantation on the effect of living related donation.…”

Section: Discussionmentioning

confidence: 98%

Increased glomerulonephritis recurrence after living related donation

2017

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BackgroundKidney transplantation confers superior outcomes for patients with end stage kidney disease, and live donor kidneys associate with superior outcomes compared to deceased donor kidneys. Modern immunosuppression has improved rejection rates and transplant survival and, as a result, recurrence of glomerulonephritis has emerged as a major cause of allograft loss. However, many glomerulonephritides have significant genetic risk which may manifest through kidney intrinsic or systemic mechanisms. We hypothesise that heritable kidney intrinsic predisposition to glomerulonephritis will result in increased risk of glomerulonephritis recurrence in kidneys transplanted from genetically related donors.MethodsWe investigated the effect of living related donation on rates of recurrence and subsequent graft outcomes in 7236 patient from 28 years of ANZDATA transplant registry data. Data were analysed in R, using Kaplan Meier Survival analysis and adjusted analyses performed using Cox Proportional Hazards methods. A competing risk model was also analysed.ResultsGlomerulonephritis recurrence rates were significantly higher in living related donor grafts compared to either living unrelated or deceased donor grafts (p < 0 · 001). In IgA nephropathy, transplantation from living related donor kidneys demonstrated a 10 year recurrence rate of 16 · 7% compared to 7 · 1% in living unrelated donors and 9 · 2% in deceased donors (HR:1 · 7, 95% CI:1 · 26–2 · 26, p = 0 · 0005 for living related vs deceased donors). In focal segmental glomerulosclerosis, risk of recurrence at 10 years was 14 · 6% in living related donors compared to 10 · 8% in living unrelated donors and 6 · 6% in deceased donors (HR:2 · 2, 95% CI 1 · 34–3 · 64, p = 0 · 002) for living related vs deceased donors. Primary glomerulonephritis death censored graft survival was superior for living donor grafts, related or unrelated, compared to deceased donor grafts.ConclusionsWe identified a significant increase in the risk of glomerulonephritis recurrence in IgA Nephropathy and Focal Segmental Glomerulosclerosis in living related donors compared to a deceased donors.

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Section: Discussionmentioning

confidence: 98%

Increased glomerulonephritis recurrence after living related donation

2017

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“…Moroni et al reported a recurrence rate of 25 % among MPGN type I patients [ 12 ]. Green et al reported a recurrence rate of only 19 %, and Braun et al reported a recurrence rate among pediatric MPGN type II patients of 43 % [ 7 , 11 ]. Thus the recurrence rate that we report is generally consistent with that reported in previous cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…Consistent with previous reports, 55 % of MPGN recurrences were diagnosed within the first year of kidney transplantation. In the studies by Lorenz et al and Green et al, all cases were diagnosed within 1.2 and 2.6 years of transplantation respectively [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, these studies assessed MPGN recurrence based on the old classification system. MPGN often recurs after kidney transplantation and the reported rate of recurrence of MPGN is quite variable (19–65 %) depending on the study [ 7 – 9 ]. What was formerly called MPGN type II was found to be associated with the highest rate of recurrence after transplantation [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…What was formerly called MPGN type II was found to be associated with the highest rate of recurrence after transplantation [ 10 , 11 ]. Recurrence after transplantation was found to be associated with the presence of monoclonal immunoglobulins [ 8 ], lower serum complement level [ 8 ], higher proteinuria [ 11 ], human leukocyte antigen (HLA) B8, DR3 [ 9 ], B49, and DR4 [ 7 ], and the presence of crescents in the original biopsy [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Membranoproliferative glomerulonephritis recurrence after kidney transplantation: using the new classification

et al. 2016

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BackgroundMembranoproliferative glomerulonephritis (MPGN) is an uncommon glomerular disorder that may lead to end stage renal disease (ESRD). With new understanding of the disease pathogenesis, the classical classification as MPGN types I, II, III has changed. Data on post-transplant MPGN, in particular with the newly refined classification, is limited. We present our center’s experience of MPGN after kidney transplantation using the new classification.MethodsThis is a retrospective study of 34 patients with ESRD due to MPGN who received 40 kidney transplants between 1994 and 2014. We reviewed the available biopsies’ data using the new classification. We assessed post transplantation recurrence rate, risk factors of recurrence, the response to therapy and allografts’ survival.ResultsMedian time of follow up was 5.3 years (range 0.5–14 years). Using the new classification, we found that pre-transplant MPGN disease was due to immune complex-mediated glomerulonephritis (ICGN) in 89 % of cases and complement-mediated glomerulonephritis (CGN) in 11 %. Recurrence was detected in 18 transplants (45 %). Living related allografts (P = 0.045), preemptive transplantations (P = 0.018), low complement level (P = 0.006), and the presence of monoclonal gammopathy (P = 0.010) were associated with higher recurrence rate in ICGN cases. Half of the patients with recurrence lost their allografts. The use of ACEi/ARB was associated with a trend toward less allograft loss.ConclusionsMPGN recurs at a high rate after kidney transplantation. The risk of MPGN recurrence increases with preemptive transplantation, living related donation, low complement level, and the presence of monoclonal gammopathy. Recurrence of MPGN leads to allograft failure in half of the cases.

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