Association of HLA Typing and Alloimmunity With Posttransplantation Membranous Nephropathy: A Multicenter Case Series.
Adult
Aged
Allografts
/ immunology
Europe
/ epidemiology
Female
Glomerulonephritis, Membranous
/ epidemiology
HLA Antigens
/ analysis
Histocompatibility Testing
Humans
Immunosuppressive Agents
Isoantibodies
/ immunology
Isoantigens
/ immunology
Kidney Transplantation
Male
Middle Aged
North America
/ epidemiology
Postoperative Complications
/ etiology
Receptors, Phospholipase A2
/ immunology
Recurrence
Retrospective Studies
HLA
HLA-A3
Membranous nephropathy (MN)
allograft
allograft biopsy
allograft survival
antibody-mediated rejection (AMR)
case series
de novo glomerulonephritis
humoral alloimmunity
pathology
phospholipase A(2) receptor (PLA(2)R)
recurrent glomerulonephritis
renal transplantation
steroid-free immunosuppression
Journal
American journal of kidney diseases : the official journal of the National Kidney Foundation
ISSN: 1523-6838
Titre abrégé: Am J Kidney Dis
Pays: United States
ID NLM: 8110075
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
28
08
2019
accepted:
07
01
2020
pubmed:
4
5
2020
medline:
9
10
2020
entrez:
4
5
2020
Statut:
ppublish
Résumé
Posttransplantation membranous nephropathy (MN) represents a rare complication of kidney transplantation that can be classified as recurrent or de novo. The clinical, pathologic, and immunogenetic characteristics of posttransplantation MN and the differences between de novo and recurrent MN are not well understood. Multicenter case series. We included 77 patients from 5 North American and European medical centers with post-kidney transplantation MN (27 de novo and 50 recurrent). Patients with MN in the native kidney who received kidney allografts but did not develop recurrent MN were used as nonrecurrent controls (n = 43). To improve understanding of posttransplantation MN, we compared de novo MN with recurrent MN and then contrasted recurrent MN with nonrecurrent controls. Compared with recurrent MN, de novo MN was less likely to be classified as primary MN (OR, 0.04; P < 0.001) and had more concurrent antibody-mediated rejection (OR, 12.0; P < 0.001) and inferior allograft survival (HR for allograft failure, 3.2; P = 0.007). HLA-DQ2 and HLA-DR17 antigens were more common in recipients with recurrent MN compared with those with de novo MN; however, the frequency of these recipient antigens in recurrent MN was similar to that in nonrecurrent MN controls. Among the 93 kidney transplant recipients with native kidney failure attributed to MN, older recipient age (HR per each year older, 1.03; P = 0.02), recipient HLA-A3 antigen (HR, 2.5; P = 0.003), steroid-free immunosuppressive regimens (HR, 2.84; P < 0.001), and living related allograft (HR, 1.94; P = 0.03) were predictors of MN recurrence. Retrospective case series, limited sample size due to rarity of the disease, nonstandardized nature of data collection and biopsies. De novo and recurrent MN likely represent separate diseases. De novo MN is associated with humoral alloimmunity and guarded outcome. Potential predisposing factors for recurrent MN include recipients who are older, recipient HLA-A3 antigen, steroid-free immunosuppressive regimen, and living related donor kidney.
Identifiants
pubmed: 32359820
pii: S0272-6386(20)30534-5
doi: 10.1053/j.ajkd.2020.01.009
pmc: PMC7483441
mid: NIHMS1568542
pii:
doi:
Substances chimiques
HLA Antigens
0
Immunosuppressive Agents
0
Isoantibodies
0
Isoantigens
0
Receptors, Phospholipase A2
0
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
374-383Subventions
Organisme : NIDDK NIH HHS
ID : R01 DK105124
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK116066
Pays : United States
Organisme : NIDDK NIH HHS
ID : RC2 DK116690
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK114893
Pays : United States
Organisme : NIDDK NIH HHS
ID : U24 DK114886
Pays : United States
Informations de copyright
Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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