Recurrence of membranous nephropathy after kidney transplantation: A multicenter retrospective cohort study

Hullekes, Frank; Buxeda, Anna; Pérez-Sáez, María José; Arias Cabrales, Carlos Enrique; Riella, Leonardo V.

doi:http://dx.doi.org/10.1016/j.ajt.2024.01.036

Recurrence of membranous nephropathy after kidney transplantation: A multicenter retrospective cohort study

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Hullekes F, Uffing A, Verhoeff R, Seeger H, von Moos S, Mansur J, et al. Recurrence of membranous nephropathy after kidney transplantation: A multicenter retrospective cohort study. Am J Transplant. 2024 Jun;24(6):1016-26. DOI: 10.1016/j.ajt.2024.01.036

Abstract

Membranous nephropathy (MN) is a leading cause of kidney failure worldwide and frequently recurs after transplant. Available data originated from small retrospective cohort studies or registry analyses; therefore, uncertainties remain on risk factors for MN recurrence and response to therapy. Within the Post-Transplant Glomerular Disease Consortium, we conducted a retrospective multicenter cohort study examining the MN recurrence rate, risk factors, and response to treatment. This study screened 22,921 patients across 3 continents and included 194 patients who underwent a kidney transplant due to biopsy-proven MN. The cumulative incidence of MN recurrence was 31% at 10 years posttransplant. Patients with a faster progression toward end-stage kidney disease were at higher risk of developing recurrent MN (hazard ratio [HR], 0.55 per decade; 95% confidence interval [CI], 0.35-0.88). Moreover, elevated pretransplant levels of anti-phospholipase A2 receptor (PLA2R) antibodies were strongly associated with recurrence (HR, 18.58; 95% CI, 5.37-64.27). Patients receiving rituximab for MN recurrence had a higher likelihood of achieving remission than patients receiving renin-angiotensin-aldosterone system inhibition alone. In sum, MN recurs in one-third of patients posttransplant, and measurement of serum anti-PLA2R antibody levels shortly before transplant could aid in risk-stratifying patients for MN recurrence. Moreover, patients receiving rituximab had a higher rate of treatment response.