Recurrence of membranous nephropathy after kidney transplantation: A multicenter retrospective cohort study
Frank Hullekes, Audrey Uffing, Rucháma Verhoeff, Harald Seeger, Seraina von Moos, Juliana Mansur, Gianna Mastroianni Kirsztajn, Hélio Tedesco‐Silva, Anna Buxeda, María José Pérez‐Sáez, Carlos Arias-Cabrales, A. Bernard Collins, Christie Swett, Leela Morená, Marina Loucaidou, Andreas Kousios, Paolo Malvezzi, Mathilde Bugnazet, Luis Sanchez Russo, Saif A. Muhsin, Nikhil Agrawal, Pitchaphon Nissaisorakarn, Het Patel, Ayman Al Jurdi, Enver Akalin, Elias David‐Neto, Fabiana Agena, Carlucci Gualberto Ventura, Roberto Ceratti Manfro, Andréa Carla Bauer, Marilda Mazzali, Marcos Vinícius de Sousa, Gaetano La Manna, Claudia Bini, Giorgia Comai, Roman Reindl‐Schwaighofer, Stefan P. Berger, Paolo Cravedi, Leonardo V. Riella
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.