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.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.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.doi http://dx.doi.org/10.1093/ckj/sfad077
• dc.identifier.issn 2048-8505
• dc.identifier.uri http://hdl.handle.net/10230/59977
• 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.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
• dc.subject.keyword Kidney transplantation
• dc.subject.keyword Membranous nephropathy
• dc.subject.keyword Proteinuria
• dc.subject.keyword Recurrence
• dc.subject.keyword Tacrolimus
• 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.type.version info:eu-repo/semantics/publishedVersion