Recurrence of Primary Glomerular Disease is the 3rd most common cause of graft failure.Membranous GN has a Recurrence post transplant rate of : 30-40% , Usually diagnosed between 2nd-3rd year post transplant. The graft survival is not different than that of patients with other renal diseases. One major study in NDT in 2010 is the only one that really looked at post transplant membranous GN and what happens to those patients. They had 12 patients with recurrence of Membranous. In th 118 month follow up, patient survival was 96% and graft survival was around 40% when compared to controls. Recurrence led to graft loss in 6 patients, all were DDRTx and in 55 months. Recurrence was more common in females. The ones with higher proteinuria did worse. This showed that they did similar patterns as regular Membranous GN.
Another study done recently in 2010 showed that recurrence might be lower compared to previously thought due to being on strong anti rejection agents. The incidence of recurrent iMN was 44%, and recurrences occurred at a median time of 13.6 months after transplantation. Two patterns of recurrence were identified: Early and late. No predictors of recurrence or disease progression could be identified. Anti CD20 agents might be useful in treating this post recurrence.
So really, no good overall data out there. Here are a list of references.
Post by Hitesh Patni, MD
Dr Patni is a renal fellow at the Hofstra NSLIJ School of Medicine
Ref:
http://www.ncbi.nlm.nih.gov/pubmed/12110738
http://www.ncbi.nlm.nih.gov/pubmed/21030574
http://www.ncbi.nlm.nih.gov/pubmed/20466669
http://www.ncbi.nlm.nih.gov/pubmed/20185599
Differentiating from de novo MN is important. Mostly de novo MN is associated with Chronic rejection. In addition, Anti PLA2R1 antibodies may be associated with recurrence? and not with de novo membranous nephropathy post transplant.
ReplyDeletehttp://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2011.03643.x/abstract