De novo and recurrent membranous glomerulopathy following kidney transplantation

Abstract

Membranous glomerulopathy, de novo or recurrent, in the allograft kidney is a recognized, albeit uncommon, clinical entity. We examined the records of 936 renal allograft recipients in a seven and one-half year period. De novo membranous glomerulopathy developed in six patients. The mean onset of nephrotic-range proteinuria after transplantation was at 18.1 months (with a range of from 4 to 30 months). De novo membranous glomerulopathy did not adversely affect graft survival. Twenty-five patients were transplanted for end-stage renal disease caused by membranous glomerulopathy. The rate of recurrence of membranous glomerulopathy in patients who did not lose their allograft to rejection in the immediate posttransplant period was 7%. Additional prednisone therapy to the standard immunosuppressive protocol did not appear to be beneficial. One patient, who developed a recurrence of the original lesion, received an HLA-identical kidney. Onset of nephrotic-range proteinuria occurred four weeks post-transplant. Recurrent membranous glomerulopathy has been reported in five other patients. In the two recipients of living related allografts nephrotic-range proteinuria developed within two weeks of the transplant. Patients with end-stage renal disease caused by membranous glomerulopathy who receive a living related allograft, especially one that is HLA-identical, may be at a higher risk for morbidity and for early recurrence. We recommend caution in the use of a living related transplant for patients with end-stage renal disease caused by membranous glomerulopathy.