Kidney Transplant Recipients With Primary Membranous Glomerulonephritis Have a Higher Risk of Acute Rejection Compared With Other Primary Glomerulonephritides

Tripti Singh, Brad Astor, Weixiong Zhong, Didier Mandelbrot, Arjang Djamali, Sarah Panzer, Tripti Singh, Brad Astor, Weixiong Zhong, Didier Mandelbrot, Arjang Djamali, Sarah Panzer

Abstract

Background: Despite being the leading cause of graft failure, there is a lack of published data about the rates of rejection in kidney transplant patients with glomerulonephritis as the cause of end-stage renal disease.

Methods: We examined all consecutive adult (>18 years) renal transplant recipients with biopsy-proven native renal glomerular disease who underwent kidney transplant between 1994 and 2013. Glomerulonephritis groups included were IgA nephropathy (IgAN) (N = 306), focal segmental glomerulosclerosis (FSGS) (N = 298), membranous nephropathy (MN) (N = 81), and lupus nephritis (LN) (N = 177).

Results: In the total cohort of 862 patients, 363 patients had an episode of acute rejection during the follow-up period of 19 years (incidence rate of 7.2% per year). Forty-five of 81 patients with MN had an episode of acute rejection during the follow-up period. Patients with MN had significantly higher incidence of acute rejection (12.1 per 100 person years, P < 0.05) in comparison to IgAN (7.2 per 100 person years), FSGS (7.4 per 100 person years), and LN (7.9 per 100 person years). Patients with MN had 1.9 times higher risk of developing acute rejection after transplant in comparison to IgAN (P < 0.005). In patients with MN, 33 of 45 (73.3%) rejection events were acute cellular rejection, 8 (17.8%) of 45 were acute antibody-mediated rejection and 6 of 45 (13.3%) were combined cellular and antibody-mediated acute rejection. Despite higher rates of acute rejection, 10-year allograft survival was similar in all subgroups.

Conclusions: Patients with MN have higher incidence of acute rejection after kidney transplant but have similar 10-year allograft survival in comparison to the other glomerular diseases like IgAN, FSGS, and LN.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
A, Kaplan-Meier curve of 10-year rejection free survival for kidney transplant patients by native glomerular disease diagnosis after acute rejection. IgAN (solid gray line), FSGS (dashed black line), MN (dashed gray line) or LN (solid black line). P = 0.004 for MN compared with IgAN. B, Types of acute rejection in patients with MN as cause of ESRD after kidney transplant. Acute cellular rejection (Black), acute antibody-mediated rejection (light gray), combined acute cellular and antibody-mediated rejection (dark gray).
FIGURE 2
FIGURE 2
Kaplan-Meier curve of 10-year allograft survival for kidney transplant patients by native glomerular disease diagnosis after acute rejection. IgAN (solid gray line), FSGS (dashed black line), MN (dashed gray line) or LN (solid black line).

References

    1. United States Renal Data System. 2015 annual data report. . Published 2015.
    1. Briganti EM, Russ GR, McNeil JJ, et al. Risk of renal allograft loss from recurrent glomerulonephritis. N Engl J Med. 2002;347:103–109.
    1. Harada KM, Mandia-Sampaio EL, de Sandes-Freitas TV, et al. Risk factors associated with graft loss and patient survival after kidney transplantation. Transplant Proc. 2009;41:3667–3670.
    1. Hariharan S, Adams MB, Brennan DC, et al. Recurrent and de novo glomerular disease after renal transplantation: a report from Renal Allograft Disease Registry (RADR). Transplantation. 1999;68:635–641.
    1. Dabade TS, Grande JP, Norby SM, et al. Recurrent idiopathic membranous nephropathy after kidney transplantation: a surveillance biopsy study. Am J Transplant. 2008;8:1318–1322.
    1. Cosio FG, Cattran DC. Recent advances in our understanding of recurrent primary glomerulonephritis after kidney transplantation. Kidney Int. 2017;91:304–314.
    1. Pruthi R, McClure M, Casula A, et al. Long-term graft outcomes and patient survival are lower posttransplant in patients with a primary renal diagnosis of glomerulonephritis. Kidney Int. 2016;89:918–926.
    1. Sanfilippo F, Vaughn WK, LeFor WM, et al. Multivariate analysis of risk factors in cadaver donor kidney transplantation. Transplantation. 1986;42:28–34.
    1. Aydingoz SE, Takemoto SK, Pinsky BW, et al. The impact of human leukocyte antigen matching on transplant complications and immunosuppression dosage. Hum Immunol. 2007;68:491–499.
    1. Kerman RH, Kimball PM, Van Buren CT, et al. Possible contribution of pretransplant immune responder status to renal allograft survival differences of black versus white recipients. Transplantation. 1991;51:338–342.
    1. Thibaudin D, Alamartine E, de Filippis JP, et al. Advantage of antithymocyte globulin induction in sensitized kidney recipients: a randomized prospective study comparing induction with and without antithymocyte globulin. Nephrol Dial Transplant. 1998;13:711–715.
    1. Beck LH, Jr, Bonegio RG, Lambeau G, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. 2009;361:11–21.
    1. Colvin RB, Smith RN. Antibody-mediated organ-allograft rejection. Nat Rev Immunol. 2005;5:807–817.
    1. Hart A, Smith JM, Skeans MA, et al. OPTN/SRTR annual data report kidney. Am J Transplant. 2014;16(Suppl 2):11–46.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe