Keywords
Primary glomerulopathies
membranous nephropathy
antiPLA2R
recurrence
risk factors
How to Cite
Abstract
Background: Recurrence of primary kidney disease in the renal allograft is the third leading cause of graft failure. Similar to other glomerular diseases, membranous nephropathy (MN) may recur after kidney transplantation and adversely affect graft and patient outcomes. Several risk factors for recurrence have been identified, most notably the presence of anti-phospholipase A2 receptor antibodies before transplantation. Higher antibody titers have been associated with an increased risk of recurrence. Therefore, careful pretransplant risk assessment is essential to establish appropriate post-transplant surveillance strategies, enabling early diagnosis and timely therapeutic intervention.
Objective: To review the current evidence on the epidemiology, risk factors, diagnosis, and treatment of recurrent MN after kidney transplantation.
Methods: A non-systematic literature search was conducted in the PubMed database to identify studies addressing recurrent membranous nephropathy after kidney transplantation. Observational studies, clinical trials, review articles, and clinical practice guidelines evaluating pretransplant and post-transplant assessment, as well as therapeutic strategies, were included.
Results: Recurrence of membranous nephropathy (MN) after kidney transplantation is variable and is associated with an increased risk of graft loss. The presence and higher titers of anti-PLA2R antibodies before transplantation are the main factors associated with recurrence. Monitoring anti-PLA2R antibodies and proteinuria may help identify patients at higher risk and facilitate early diagnosis. Rituximab is the main therapeutic strategy described, although the available evidence is limited.
Conclusions: Recurrence of MN requires individualized risk assessment beginning in the pretransplant period and close post-transplant monitoring. Monitoring anti-PLA2R antibodies and proteinuria may facilitate timely diagnosis and treatment.
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