BACKGROUND: The etiology of de novo membranous nephropathy (MN) after kidney transplantation is still uncertain. Immunological response to various allograft antigens is speculated to be a candidate for the etiology. METHODS: Seventeen patients with post-transplant de novo MN were studied clinically and pathologically in comparison with control post-transplant patients without MN. Double immunofluorescent staining was performed to identify the presence of donor-specific human leukocyte antigen (HLA) combined with IgG in the deposits on glomerular capillary walls. RESULTS: De novo MN occurs in relatively late period after transplantation (102.1 ± 68.3 months), presenting various degree of proteinuria. Histological findings associated with antibody-mediated rejection (AMR), such as peritubular capillaritis and C4d deposition in peritubular capillary, were more frequently observed in the patients with de novo MN than the non-MN control patients. Donor-specific antibody (DSA) was detected in five patients at the time of biopsy. In one case of de novo MN with DSA, a donor-derived HLA was identified in the subepithelial deposits on the glomerular capillary walls combined with IgG deposition. CONCLUSIONS: DSA and AMR might play some roles for the pathogenesis in some patients with de novo MN after kidney transplantation.
BACKGROUND: The etiology of de novo membranous nephropathy (MN) after kidney transplantation is still uncertain. Immunological response to various allograft antigens is speculated to be a candidate for the etiology. METHODS: Seventeen patients with post-transplant de novo MN were studied clinically and pathologically in comparison with control post-transplant patients without MN. Double immunofluorescent staining was performed to identify the presence of donor-specific human leukocyte antigen (HLA) combined with IgG in the deposits on glomerular capillary walls. RESULTS: De novo MN occurs in relatively late period after transplantation (102.1 ± 68.3 months), presenting various degree of proteinuria. Histological findings associated with antibody-mediated rejection (AMR), such as peritubular capillaritis and C4d deposition in peritubular capillary, were more frequently observed in the patients with de novo MN than the non-MN control patients. Donor-specific antibody (DSA) was detected in five patients at the time of biopsy. In one case of de novo MN with DSA, a donor-derived HLA was identified in the subepithelial deposits on the glomerular capillary walls combined with IgG deposition. CONCLUSIONS:DSA and AMR might play some roles for the pathogenesis in some patients with de novo MN after kidney transplantation.
Authors: Marc Xipell; Lida M Rodas; Jesús Villarreal; Alicia Molina; Johanna Reinoso-Moreno; Miquel Blasco; Esteban Poch; Fritz Diekmann; Jose M Campistol; Luis F Quintana Journal: Clin Kidney J Date: 2017-11-22
Authors: Wen-Ling Yang; Bhadran Bose; Lei Zhang; Megan Mcstea; Yeoungjee Cho; Magid Fahim; Carmel M Hawley; Elaine M Pascoe; David W Johnson Journal: PLoS One Date: 2019-08-23 Impact factor: 3.240