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High exposure to tacrolimus is associated with spontaneous remission of recurrent membranous nephropathy after kidney transplantation

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dc.contributor.author Buxeda, Anna
dc.contributor.author Caravaca Fontán, Fernando
dc.contributor.author Vigara, Luis Alberto
dc.contributor.author Pérez Canga, José Luis
dc.contributor.author Calatayud, Emma
dc.contributor.author Coloma, Ana
dc.contributor.author Mazuecos, Auxiliadora
dc.contributor.author Rodrigo Calabia, Emilio
dc.contributor.author Sancho, Asunción
dc.contributor.author Melilli, Edoardo
dc.contributor.author Praga, Manuel
dc.contributor.author Pérez-Sáez, María José
dc.contributor.author Pascual Santos, Julio
dc.date.accessioned 2024-05-03T05:53:46Z
dc.date.available 2024-05-03T05:53:46Z
dc.date.issued 2023
dc.identifier.citation Buxeda A, Caravaca-Fontán F, Vigara LA, Pérez-Canga JL, Calatayud E, Coloma A, et al. High exposure to tacrolimus is associated with spontaneous remission of recurrent membranous nephropathy after kidney transplantation. Clin Kidney J. 2023 Apr 12;16(10):1644-55. DOI: 10.1093/ckj/sfad077
dc.identifier.issn 2048-8505
dc.identifier.uri http://hdl.handle.net/10230/59977
dc.description.abstract Introduction: We aimed to characterize the incidence and clinical presentation of membranous nephropathy (MN) after kidney transplantation (KT), and to assess allograft outcomes according to proteinuria rates and immunosuppression management. Methods: Multicenter retrospective cohort study including patients from six Spanish centers who received a KT between 1991-2019. Demographic, clinical, and histological data were collected from recipients with biopsy-proven MN as primary kidney disease (n = 71) or MN diagnosed de novo after KT (n = 4). Results: Up to 25.4% of patients with biopsy-proven MN as primary kidney disease recurred after a median time of 18.1 months posttransplant, without a clear impact on graft survival. Proteinuria at 3-months post-KT was a predictor for MN recurrence (rMN, HR 4.28; P = 0.008). Patients who lost their grafts had higher proteinuria during follow-up [1.0 (0.5-2.5) vs 0.3 (0.1-0.5) g/24 h], but only eGFR after recurrence treatment predicted poorer graft survival (eGFR < 30 ml/min: RR = 6.8). We did not observe an association between maintenance immunosuppression and recurrence diagnosis. Spontaneous remission after rMN was associated with a higher exposure to tacrolimus before recurrence (trough concentration/dose ratio: 2.86 vs 1.18; P = 0.028). Up to 94.4% of KT recipients received one or several treatments after recurrence onset: 22.2% rituximab, 38.9% increased corticosteroid dose, and 66.7% ACEi/ARBs. Only 21 patients had proper antiPLA2R immunological monitoring. Conclusions: One-fourth of patients with biopsy-proven MN as primary kidney disease recurred after KT, without a clear impact on graft survival. Spontaneous remission after rMN was associated with a higher exposure to tacrolimus before recurrence.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Oxford University Press
dc.relation.ispartof Clin Kidney J. 2023 Apr 12;16(10):1644-55
dc.rights © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
dc.title High exposure to tacrolimus is associated with spontaneous remission of recurrent membranous nephropathy after kidney transplantation
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1093/ckj/sfad077
dc.subject.keyword Kidney transplantation
dc.subject.keyword Membranous nephropathy
dc.subject.keyword Proteinuria
dc.subject.keyword Recurrence
dc.subject.keyword Tacrolimus
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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