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Reccurent membranous nephropathy in the kidney allgraft (Master thesis)

Παναγάκης, Αναστάσιος/ Panagakis, Anastasios

The recurrence of idiopathic membranous nephropathy (iMN) remains a factor of graft loss. A systematic literature review was conducted as data on graft survival remain lacking. Twelve (12) articles were included, published from 1995 to 2016, reporting on 139 transplanted patients with recurrent iMN. The mean age was 47.82 years and there was a predominance in male sex (71.54%) and in renal grafts from living donors (72.36%). The diagnosis of recurrent iMN was based on biopsies mostly based on indications (66.41%) and 55 (39.56%) patients received rituximab as treatment for recurrence. A total 30 from 139 grafts did not survive and compared with 138 patients from the control group the relative probability of graft loss due to iMN recurrence was 1.03 times higher (odds ratio = 1.03, 95% CI: 0.52 – 2.04, p=0.524, I 2=0.00%) without this being statistically significant. The median time of the diagnosis of recurrent iMN was 18 months in follow-up from 35 to 120 months.81.80% of patients who received rituximab as treatment for iMN recurrence achieved complete and partial remission, while 18.20% had no response to treatment. In the pretransplant period, 37 (26.61%) patients had positive serum test and 18 (12.94%) patients had positive biopsy stain for anti-PLA2R antibodies. The sensitivity of pretransplant positive serum test for these antibodies ranges from 57% to 85.30% and the specificity is 85.10% - 100%. Risk factors for iMN recurrence in the renal allograft are the positive serum test for anti-PLA2R antibodies pretransplant, female sex, younger age, high proteinuria pretransplant, the longest interval from initial disease to end-stage chronic kidney disease and the combination of alleles HLA DQA1 05:01 and HLA DQB1 02:01. The main outcome from this systematic review is that there is no statistically significant difference in graft survival in patients with iMN recurrence compared to those without recurrence.