Skip to main content

ORIGINAL RESEARCH article

Front. Nephrol.
Sec. Kidney Transplantation
Volume 4 - 2024 | doi: 10.3389/fneph.2024.1438065

De Novo and Recurrent Post-Transplant Membranous Nephropathy Cases Show Similar Rates of Concurrent Antibody-Mediated Rejection

Provisionally accepted
Nikka Khorsandi Nikka Khorsandi 1Hwarang S. Han Hwarang S. Han 2,3Rajalingam Raja Rajalingam Raja 4Jun Shoji Jun Shoji 2,5Anatoly Urisman Anatoly Urisman 1*
  • 1 University of California, San Francisco - Department of Pathology, San Francisco, United States
  • 2 Division of Nephrology, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, United States
  • 3 Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, Texas, United States
  • 4 Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California San Francisco, San Francisco, United States
  • 5 Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, California, United States

The final, formatted version of the article will be published soon.

    Background: Membranous nephropathy (MN) can develop post-kidney transplant and is classified as a recurrent disease in patients with a history of MN in the native kidneys or as de novo disease in patients without such history. The mechanism of recurrent MN is thought to be like that of primary MN, but the mechanism of de novo MN is not well delineated. An association between de novo MN and antibody-mediated rejection (AMR) has been suggested. Methods: A search of the pathology database from our medical center identified 11 cases of recurrent and 15 cases of de novo MN, in which clinical and histologic findings were compared. No significant differences were identified in the demographic characteristics, serum creatinine and proteinuria trends, or rates of allograft failure between the recurrent and de novo MN groups. Results: Rates of concurrent AMR were high in both groups (36% and 40%, respectively) but not statistically different from each other. PLA2R immunofluorescence (IF) positivity was seen in 64% of recurrent MN cases compared to 33% of de novo MN cases, suggesting a higher incidence of PLA2R-positive de novo MN than previously reported. No significant histologic differences were identified in the initial biopsies from the two groups, except mean IgG intensity by IF was higher on average in the recurrent group, suggesting a higher load of immune complex deposits at diagnosis in this group. Conclusions: The findings do not provide support for a specific association between AMR and de novo MN, but whether there is a possible link between both forms of post-transplant MN and AMR remains an unanswered question.

    Keywords: Membranous nephropathy (MN), Transplant kidney, Transplant kidney pathology, antibody mediated allograft rejection, De novo membranous nephropathy, recurrent membranous nephropathy

    Received: 24 May 2024; Accepted: 29 Jul 2024.

    Copyright: © 2024 Khorsandi, Han, Raja, Shoji and Urisman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Anatoly Urisman, University of California, San Francisco - Department of Pathology, San Francisco, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.