American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2024
Recurrence of membranous nephropathy after kidney transplantation: A multicenter retrospective cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Hullekes Frank, Uffing Audrey, Verhoeff Rucháma, Seeger Harald, von Moos Seraina, Mansur Juliana, Mastroianni-Kirsztajn Gianna, Silva Helio Tedesco, Buxeda Anna, Pérez-Sáez María José, Arias-Cabrales Carlos, Collins A Bernard, Swett Christie, Morená Leela, Loucaidou Marina, Kousios Andreas, Malvezzi Paolo, Bugnazet Mathilde, Russo Luis Sanchez, Muhsin Saif A, Agrawal Nikhil, Nissaisorakarn Pitchaphon, Patel Het, Al Jurdi Ayman, Akalin Enver, Neto Elias David, Agena Fabiana, Ventura Carlucci, Manfro Roberto C, Bauer Andrea Carla, Mazzali Marilda, de Sousa Marcos Vinicius, La Manna Gaetano, Bini Claudia, Comai Giorgia, Reindl-Schwaighofer Roman, Berger Stefan, Cravedi Paolo, Riella Leonardo V
Аннотация
Membranous nephropathy (MN) is a leading cause of kidney failure worldwide and frequently recurs after transplant. Available data originated from small retrospective cohort studies or registry analyses; therefore, uncertainties remain on risk factors for MN recurrence and response to therapy. Within the Post-Transplant Glomerular Disease Consortium, we conducted a retrospective multicenter cohort study examining the MN recurrence rate, risk factors, and response to treatment. This study screened 22,921 patients across 3 continents and included 194 patients who underwent a kidney transplant due to biopsy-proven MN. The cumulative incidence of MN recurrence was 31% at 10 years posttransplant. Patients with a faster progression toward end-stage kidney disease were at higher risk of developing recurrent MN (hazard ratio [HR], 0.55 per decade; 95% confidence interval [CI], 0.35-0.88). Moreover, elevated pretransplant levels of anti-phospholipase A2 receptor (PLA2R) antibodies were strongly associated with recurrence (HR, 18.58; 95% CI, 5.37-64.27). Patients receiving rituximab for MN recurrence had a higher likelihood of achieving remission than patients receiving renin-angiotensin-aldosterone system inhibition alone. In sum, MN recurs in one-third of patients posttransplant, and measurement of serum anti-PLA2R antibody levels shortly before transplant could aid in risk-stratifying patients for MN recurrence. Moreover, patients receiving rituximab had a higher rate of treatment response.