Recurrence of immune complex and complement-mediated membranoproliferative glomerulonephritis in kidney transplantation
Por:
Caravaca-Fontán F, Polanco N, Villacorta B, Buxeda A, Coca A, Ávila A, Martínez-Gallardo R, Galeano C, Valero R, Ramos N, Allende N, Cruzado-Vega L, Pérez-Sáez MJ, Sevillano Á, González E, Hernández A, Rodrigo E, Fernández-Ruiz M, Aguado JM, Valdivia MÁP, Pascuall J, Andrés A and Praga M
Publicada:
23 ene 2023
Ahead of Print:
1 abr 2022
Resumen:
Introduction Membranoproliferative glomerulonephritis (MPGN) represents a histologic pattern of glomerular injury that may be due to several aetiologies. Few studies have comprehensively analysed the recurrence of MPGN according to the current classification system. Methods We collected a multicentre, retrospective cohort of 220 kidney graft recipients with biopsy-proven native kidney disease due to MPGN between 1981 and 2021 in 11 hospitals. Demographic, clinical and histologic parameters of prognostic interest were collected. The main outcomes were time to kidney failure, time to recurrence of MPGN and disease remission after recurrence. Results The study group included 34 complement-mediated and 186 immune complex-mediated MPGN. A total of 81 patients (37%) reached kidney failure in a median follow-up of 79 months. The main predictors of this event were the development of rejection episodes and disease recurrence. In all, 54 patients (25%) had a disease recurrence in a median of 16 months after kidney transplantation. The incidence of recurrence was higher in patients with dysproteinaemia (67%) and complement-mediated MPGN (62%). In the multivariable model, complement-mediated MPGN emerged as a predictor of recurrence. A total of 33 patients reached kidney failure after recurrence. The main determinants of no remission were early time to recurrence (<15 months), estimated glomerular filtration rate Conclusions One-fourth of the patients with native kidney disease due to MPGN developed clinical recurrence in the allograft, especially in cases with complement-mediated disease or in those associated with dysproteinaemia. The kidney outcomes of disease recurrence with currently available therapies are heterogeneous and thus more effective and individualized therapies are needed.
Filiaciones:
Caravaca-Fontán F:
Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
Polanco N:
Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
Villacorta B:
Department of Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Buxeda A:
Department of Nephrology, Hospital del Mar, Institut Mar for Medical Research, Barcelona, Spain
Coca A:
Department of Nephrology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
:
Department of Nephrology, Hospital Universitario Doctor Peset, Valencia, Spain
Martínez-Gallardo R:
Department of Nephrology, Hospital Universitario de Badajoz, Badajoz, Spain
Galeano C:
Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain
Valero R:
Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
Ramos N:
Department of Nephrology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Allende N:
Department of Nephrology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
:
Department of Nephrology, Hospital General Universitario de Elche, Elche, Spain
Pérez-Sáez MJ:
Department of Nephrology, Hospital del Mar, Institut Mar for Medical Research, Barcelona, Spain
Sevillano Á:
Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
González E:
Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
Hernández A:
Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
Rodrigo E:
Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
Fernández-Ruiz M:
Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
Aguado JM:
Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
Valdivia MÁP:
Department of Nephrology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Pascuall J:
Department of Nephrology, Hospital del Mar, Institut Mar for Medical Research, Barcelona, Spain
Andrés A:
Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
Praga M:
Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
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