Recurrent Membranous Nephropathy After Kidney Transplantation: Treatment and Long-Term Implications

Ayelet Grupper, Lynn D. Cornell, Fernando Custodio Fervenza, Laurence H. Beck, Elizabeth Lorenz, Fernando G Cosio

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

BACKGROUND: Membranous nephropathy (MN) can recur in kidney allografts leading to graft dysfunction and failure. The aims of these analyses were to assess MN recurrence, clinical and histologic progression, and response to anti-CD20 therapy. METHODS: Included were 63 kidney allograft recipients with biopsy proven primary MN followed up for 77.0 (39-113) months (median, interquartile range). Disease recurrence was diagnosed by biopsy (protocol or clinical), and follow-up was monitored by laboratory parameters and protocol biopsies. RESULTS: Thirty of 63 patients (48%) had histologic recurrence often during the first year. In 53% of the cases, recurrence was diagnosed by protocol biopsy. Recurrence risk was higher in patients with higher proteinuria pretransplant [hazard ratio = 1.869 (95% confidence interval, 1.164-3.001) per gram, P = 0.010] and those with anti-phospholipase A2 receptor antibodies [hazard ratio = 3.761 (1.635-8.652), P = 0.002]. Thirteen patients with recurrence had no clinical progression, and in 2, MN resolved histologically. Seventeen of 63 patients (27%) had progressive proteinuria and were treated with anti-CD20 antibodies, resulting in complete response in 9 (53%), partial response in 5 (29%), and no response in 3 (18%). Posttreatment biopsies were obtained in 15 patients and showed histologic resolution in 6 (40%). Disease recurrence did not correlate with graft survival. However, 5 of 11 (45.4%) graft losses were due to recurrent MN. Death-censored graft survival in MN did not differ from that of 273 control recipients with autosomal dominant polycystic kidney disease. CONCLUSIONS: Membranous nephropathy recurs in 48% of cases threatening the allograft. Treatment of early but progressive recurrence with anti-CD20 antibodies is quite effective achieving clinical remission and histologic resolution of MN.

Original languageEnglish (US)
JournalTransplantation
DOIs
StateAccepted/In press - Dec 30 2015

Fingerprint

Membranous Glomerulonephritis
Kidney Transplantation
Recurrence
Biopsy
Allografts
Graft Survival
Therapeutics
Proteinuria
Phospholipase A2 Receptors
Anti-Idiotypic Antibodies
Transplants
Kidney
Autosomal Dominant Polycystic Kidney
Clinical Protocols
Confidence Intervals
Antibodies

ASJC Scopus subject areas

  • Transplantation

Cite this

Recurrent Membranous Nephropathy After Kidney Transplantation : Treatment and Long-Term Implications. / Grupper, Ayelet; Cornell, Lynn D.; Fervenza, Fernando Custodio; Beck, Laurence H.; Lorenz, Elizabeth; Cosio, Fernando G.

In: Transplantation, 30.12.2015.

Research output: Contribution to journalArticle

Grupper, Ayelet ; Cornell, Lynn D. ; Fervenza, Fernando Custodio ; Beck, Laurence H. ; Lorenz, Elizabeth ; Cosio, Fernando G. / Recurrent Membranous Nephropathy After Kidney Transplantation : Treatment and Long-Term Implications. In: Transplantation. 2015.
@article{dbade4a8f09b429bbc672269166c8ff8,
title = "Recurrent Membranous Nephropathy After Kidney Transplantation: Treatment and Long-Term Implications",
abstract = "BACKGROUND: Membranous nephropathy (MN) can recur in kidney allografts leading to graft dysfunction and failure. The aims of these analyses were to assess MN recurrence, clinical and histologic progression, and response to anti-CD20 therapy. METHODS: Included were 63 kidney allograft recipients with biopsy proven primary MN followed up for 77.0 (39-113) months (median, interquartile range). Disease recurrence was diagnosed by biopsy (protocol or clinical), and follow-up was monitored by laboratory parameters and protocol biopsies. RESULTS: Thirty of 63 patients (48{\%}) had histologic recurrence often during the first year. In 53{\%} of the cases, recurrence was diagnosed by protocol biopsy. Recurrence risk was higher in patients with higher proteinuria pretransplant [hazard ratio = 1.869 (95{\%} confidence interval, 1.164-3.001) per gram, P = 0.010] and those with anti-phospholipase A2 receptor antibodies [hazard ratio = 3.761 (1.635-8.652), P = 0.002]. Thirteen patients with recurrence had no clinical progression, and in 2, MN resolved histologically. Seventeen of 63 patients (27{\%}) had progressive proteinuria and were treated with anti-CD20 antibodies, resulting in complete response in 9 (53{\%}), partial response in 5 (29{\%}), and no response in 3 (18{\%}). Posttreatment biopsies were obtained in 15 patients and showed histologic resolution in 6 (40{\%}). Disease recurrence did not correlate with graft survival. However, 5 of 11 (45.4{\%}) graft losses were due to recurrent MN. Death-censored graft survival in MN did not differ from that of 273 control recipients with autosomal dominant polycystic kidney disease. CONCLUSIONS: Membranous nephropathy recurs in 48{\%} of cases threatening the allograft. Treatment of early but progressive recurrence with anti-CD20 antibodies is quite effective achieving clinical remission and histologic resolution of MN.",
author = "Ayelet Grupper and Cornell, {Lynn D.} and Fervenza, {Fernando Custodio} and Beck, {Laurence H.} and Elizabeth Lorenz and Cosio, {Fernando G}",
year = "2015",
month = "12",
day = "30",
doi = "10.1097/TP.0000000000001056",
language = "English (US)",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Recurrent Membranous Nephropathy After Kidney Transplantation

T2 - Treatment and Long-Term Implications

AU - Grupper, Ayelet

AU - Cornell, Lynn D.

AU - Fervenza, Fernando Custodio

AU - Beck, Laurence H.

AU - Lorenz, Elizabeth

AU - Cosio, Fernando G

PY - 2015/12/30

Y1 - 2015/12/30

N2 - BACKGROUND: Membranous nephropathy (MN) can recur in kidney allografts leading to graft dysfunction and failure. The aims of these analyses were to assess MN recurrence, clinical and histologic progression, and response to anti-CD20 therapy. METHODS: Included were 63 kidney allograft recipients with biopsy proven primary MN followed up for 77.0 (39-113) months (median, interquartile range). Disease recurrence was diagnosed by biopsy (protocol or clinical), and follow-up was monitored by laboratory parameters and protocol biopsies. RESULTS: Thirty of 63 patients (48%) had histologic recurrence often during the first year. In 53% of the cases, recurrence was diagnosed by protocol biopsy. Recurrence risk was higher in patients with higher proteinuria pretransplant [hazard ratio = 1.869 (95% confidence interval, 1.164-3.001) per gram, P = 0.010] and those with anti-phospholipase A2 receptor antibodies [hazard ratio = 3.761 (1.635-8.652), P = 0.002]. Thirteen patients with recurrence had no clinical progression, and in 2, MN resolved histologically. Seventeen of 63 patients (27%) had progressive proteinuria and were treated with anti-CD20 antibodies, resulting in complete response in 9 (53%), partial response in 5 (29%), and no response in 3 (18%). Posttreatment biopsies were obtained in 15 patients and showed histologic resolution in 6 (40%). Disease recurrence did not correlate with graft survival. However, 5 of 11 (45.4%) graft losses were due to recurrent MN. Death-censored graft survival in MN did not differ from that of 273 control recipients with autosomal dominant polycystic kidney disease. CONCLUSIONS: Membranous nephropathy recurs in 48% of cases threatening the allograft. Treatment of early but progressive recurrence with anti-CD20 antibodies is quite effective achieving clinical remission and histologic resolution of MN.

AB - BACKGROUND: Membranous nephropathy (MN) can recur in kidney allografts leading to graft dysfunction and failure. The aims of these analyses were to assess MN recurrence, clinical and histologic progression, and response to anti-CD20 therapy. METHODS: Included were 63 kidney allograft recipients with biopsy proven primary MN followed up for 77.0 (39-113) months (median, interquartile range). Disease recurrence was diagnosed by biopsy (protocol or clinical), and follow-up was monitored by laboratory parameters and protocol biopsies. RESULTS: Thirty of 63 patients (48%) had histologic recurrence often during the first year. In 53% of the cases, recurrence was diagnosed by protocol biopsy. Recurrence risk was higher in patients with higher proteinuria pretransplant [hazard ratio = 1.869 (95% confidence interval, 1.164-3.001) per gram, P = 0.010] and those with anti-phospholipase A2 receptor antibodies [hazard ratio = 3.761 (1.635-8.652), P = 0.002]. Thirteen patients with recurrence had no clinical progression, and in 2, MN resolved histologically. Seventeen of 63 patients (27%) had progressive proteinuria and were treated with anti-CD20 antibodies, resulting in complete response in 9 (53%), partial response in 5 (29%), and no response in 3 (18%). Posttreatment biopsies were obtained in 15 patients and showed histologic resolution in 6 (40%). Disease recurrence did not correlate with graft survival. However, 5 of 11 (45.4%) graft losses were due to recurrent MN. Death-censored graft survival in MN did not differ from that of 273 control recipients with autosomal dominant polycystic kidney disease. CONCLUSIONS: Membranous nephropathy recurs in 48% of cases threatening the allograft. Treatment of early but progressive recurrence with anti-CD20 antibodies is quite effective achieving clinical remission and histologic resolution of MN.

UR - http://www.scopus.com/inward/record.url?scp=84952684011&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84952684011&partnerID=8YFLogxK

U2 - 10.1097/TP.0000000000001056

DO - 10.1097/TP.0000000000001056

M3 - Article

AN - SCOPUS:84952684011

JO - Transplantation

JF - Transplantation

SN - 0041-1337

ER -