Ibrahim Batal1, Elena-Rodica Vasilescu2, Darshana M Dadhania3, Aidoud Abderrahmane Adel4, S Ali Husain5, Rupali Avasare6, Geo Serban2, Dominick Santoriello2, Pascale Khairallah5, Ankita Patel7, Michael J Moritz8, Eva Latulippe9, Julie Riopel9, Karim Khallout4, Sidney J Swanson10, Andrew S Bomback5, Sumit Mohan11, Lloyd Ratner12, Jai Radhakrishnan5, David J Cohen5, Gerald B Appel5, Michael B Stokes2, Glen S Markowitz2, Surya V Seshan13, Sacha A De Serres14, Nicole Andeen15, Alexandre Loupy4, Krzysztof Kiryluk5, Vivette D D'Agati2. 1. Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY. Electronic address: ib2349@columbia.edu. 2. Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY. 3. Department of Medicine, Nephrology, Weill Cornell Medical College, New York, NY. 4. Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France. 5. Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY. 6. Department of Medicine, Nephrology, Oregon Health & Science University, Portland, OR. 7. Department of Medicine, Nephrology, Hackensack University Medical Center, Hackensack, NJ. 8. Department of Surgery, Lehigh Valley Health Network, Allentown, PA. 9. Department of Pathology, University Health Center of Quebec, Laval University, Québec, QC, Canada. 10. Department of Surgery, Christiana Hospital, Newark, DE. 11. Department of Medicine, Nephrology, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. 12. Department of Surgery, Columbia University Irving Medical Center, New York, NY. 13. Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY. 14. Renal Division, Department of Medicine, University Health Center of Quebec, Laval University, Québec, QC, Canada. 15. Department of Pathology, Oregon Health & Science University, Portland, OR.
Abstract
RATIONALE & OBJECTIVES: Posttransplantation membranous nephropathy (MN) represents a rare complication of kidney transplantation that can be classified as recurrent or de novo. The clinical, pathologic, and immunogenetic characteristics of posttransplantation MN and the differences between de novo and recurrent MN are not well understood. STUDY DESIGN: Multicenter case series. SETTING & PARTICIPANTS: We included 77 patients from 5 North American and European medical centers with post-kidney transplantation MN (27 de novo and 50 recurrent). Patients with MN in the native kidney who received kidney allografts but did not develop recurrent MN were used as nonrecurrent controls (n = 43). To improve understanding of posttransplantation MN, we compared de novo MN with recurrent MN and then contrasted recurrent MN with nonrecurrent controls. FINDINGS: Compared with recurrent MN, de novo MN was less likely to be classified as primary MN (OR, 0.04; P < 0.001) and had more concurrent antibody-mediated rejection (OR, 12.0; P < 0.001) and inferior allograft survival (HR for allograft failure, 3.2; P = 0.007). HLA-DQ2 and HLA-DR17 antigens were more common in recipients with recurrent MN compared with those with de novo MN; however, the frequency of these recipient antigens in recurrent MN was similar to that in nonrecurrent MN controls. Among the 93 kidney transplant recipients with native kidney failure attributed to MN, older recipient age (HR per each year older, 1.03; P = 0.02), recipient HLA-A3 antigen (HR, 2.5; P = 0.003), steroid-free immunosuppressive regimens (HR, 2.84; P < 0.001), and living related allograft (HR, 1.94; P = 0.03) were predictors of MN recurrence. LIMITATIONS: Retrospective case series, limited sample size due to rarity of the disease, nonstandardized nature of data collection and biopsies. CONCLUSIONS: De novo and recurrent MN likely represent separate diseases. De novo MN is associated with humoral alloimmunity and guarded outcome. Potential predisposing factors for recurrent MN include recipients who are older, recipient HLA-A3 antigen, steroid-free immunosuppressive regimen, and living related donor kidney.
RATIONALE & OBJECTIVES: Posttransplantation membranous nephropathy (MN) represents a rare complication of kidney transplantation that can be classified as recurrent or de novo. The clinical, pathologic, and immunogenetic characteristics of posttransplantation MN and the differences between de novo and recurrent MN are not well understood. STUDY DESIGN: Multicenter case series. SETTING & PARTICIPANTS: We included 77 patients from 5 North American and European medical centers with post-kidney transplantation MN (27 de novo and 50 recurrent). Patients with MN in the native kidney who received kidney allografts but did not develop recurrent MN were used as nonrecurrent controls (n = 43). To improve understanding of posttransplantation MN, we compared de novo MN with recurrent MN and then contrasted recurrent MN with nonrecurrent controls. FINDINGS: Compared with recurrent MN, de novo MN was less likely to be classified as primary MN (OR, 0.04; P < 0.001) and had more concurrent antibody-mediated rejection (OR, 12.0; P < 0.001) and inferior allograft survival (HR for allograft failure, 3.2; P = 0.007). HLA-DQ2 and HLA-DR17 antigens were more common in recipients with recurrent MN compared with those with de novo MN; however, the frequency of these recipient antigens in recurrent MN was similar to that in nonrecurrent MN controls. Among the 93 kidney transplant recipients with native kidney failure attributed to MN, older recipient age (HR per each year older, 1.03; P = 0.02), recipient HLA-A3 antigen (HR, 2.5; P = 0.003), steroid-free immunosuppressive regimens (HR, 2.84; P < 0.001), and living related allograft (HR, 1.94; P = 0.03) were predictors of MN recurrence. LIMITATIONS: Retrospective case series, limited sample size due to rarity of the disease, nonstandardized nature of data collection and biopsies. CONCLUSIONS: De novo and recurrent MN likely represent separate diseases. De novo MN is associated with humoral alloimmunity and guarded outcome. Potential predisposing factors for recurrent MN include recipients who are older, recipient HLA-A3 antigen, steroid-free immunosuppressive regimen, and living related donor kidney.
Authors: Catherine R Kavanagh; Francesca Zanoni; Rita Leal; Namrata G Jain; Megan Nicole Stack; Elena-Rodica Vasilescu; Geo Serban; Carley Shaut; Jeanne Kamal; Satoru Kudose; António Martinho; Rui Alves; Dominick Santoriello; Pietro A Canetta; David Cohen; Jai Radhakrishnan; Gerald B Appel; Michael B Stokes; Glen S Markowitz; Vivette D D'Agati; Krzysztof Kiryluk; Nicole K Andeen; Ibrahim Batal Journal: Glomerular Dis Date: 2021-09-24
Authors: Edmund Y M Chung; Katrina Blazek; Armando Teixeira-Pinto; Ankit Sharma; Siah Kim; Yingxin Lin; Karen Keung; Bhadran Bose; Lukas Kairaitis; Hugh McCarthy; Pierre Ronco; Stephen I Alexander; Germaine Wong Journal: Transplant Direct Date: 2022-08-04